Republic of the Philippines

Department of Education
REGION IV-A
SCHOOLS DIVISION OFFICE OF CAVITE PROVINCE

L&D PROGRAM/ACTIVITY PROPOSAL

PROPONENT’S PROFILE

School/ District/ Office

School/ Office Address

Name of Proponent

Position/ Designation of Proponent

Proponent’s Contact Number

Proponent’s Email Address

ACTIVITY PROFILE

I. Title of Activity

II. Rationale (Outline the reasons for the proposed conduct of this
activity. )

III. Statement of (Provide a brief description of the activity. State the

Terminal and Enabling rationale and declare the terminal and enabling objectives
Objectives of the activity.)

IV. Target Teaching

Participants
Male Female Total
For teachers and school
leaders, include career Teaching-related
stages, subjects taught,
Male Female Total
grade level, specialization
Non-teaching

Male Female Total

V. Professional Refer to DM No. 50, s. 2020 and choose from there the
Development applicable PD Priority which will be addressed through
Priorities your activity

VI. Professional Refer to DO No. 42, s. 2017- PPST, D0 No. 24, s. 2020-

Document Reference Code:

DOC-HRD-FR-024

Revision No.:

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 Republic of the Philippines
Department of Education
REGION IV-A
SCHOOLS DIVISION OFFICE OF CAVITE PROVINCE
Standards PPSSH and DO No. 25, s. 2020- PPSS to fill up this part
and declare the Domain, Strand and Indicator relevant to
If the participants are
your activity
teachers or school
leaders, otherwise N/A

VII. Date of Conduct (Inclusive dates and number of hours to be allotted per day)
and Duration

VIII. Modality (Face-to-face, blended, virtual, JEL, etc.)

IX. Location/ Venue/

Delivery Platform

X. Resource Requirements
(If face-to-face with venue to be procured, please specify resources needed below. Otherwise, put “N/A”.)

Specifics Quantity Remarks

e.g. Plenary Hall 1 Big hall for social distancing measures

Breakout Session Rooms 3 For group discussions

Tables 5 Rectangular tables

Seats 12 Seats arranged in a classroom type

Projector with Screen 1 Projector with Screen

Microphone 2 Wireless with batteries and reserve

Food Preferences 2 Hypoallergenic meals

WIFI connection - Reliable and stable

Others, specify 1 Posting boards for activities with metacards

1 HDMI cable wire connector
1 VGA cable wire connector

(Additional rows may be added if necessary)

XI. Funding Source Identify source of fund (HRTD, MOOE, Local Fund, SARO,
etc.); For Division Activity Proposals- indicate Activity Code
and attach the copy of Activity Request (AR) or Authority to
Conduct (ATC) generated from the PMIS.

XII. Proposed Budget

Document Reference Code:

DOC-HRD-FR-024

Revision No.:

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 Republic of the Philippines
Department of Education
REGION IV-A
SCHOOLS DIVISION OFFICE OF CAVITE PROVINCE
Item Description Quantity Unit Cost Amount

e.g. Accommodation 12 pax x 1 day P 1,200.00 /pax P 21,600.00

Batteries (AAA) 1 pack (4 pcs) P 200.00 P 200.00

Printer ink set (644) 1 set P 2,000.00 P 2000.00

Pilot sign pen 12 pcs Php 835/12 pcs P 835.00

pack

Certificate frames 1 pc P 200.00 P 200.00

(Glass, Letter size)

Certificate paper (Letter 2 packs of 10 pcs Php 45.00/pack P 90.00

size) each

Colored papers (A4 2 packs of 10 pcs Php 45.00/pack P 90.00

Size) each

Masking tape (1 inch) 1 pc Php 25.00/pc P 25.00

Small notebook 12 pcs Php 30.00/pc P 360.00

Total P 25,400.00

XIII. Program Matrix/ Design

Date/ Time Activity Speaker/ Facilitator

e.g. 8:00-8:15 Preliminaries PMT

a.m.
National Anthem
Invocation
DepEd Quality Policy
Presentation of Activity
Rationale and/ or
Objectives
Protocol

Document Reference Code:

DOC-HRD-FR-024

Revision No.:

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 Republic of the Philippines
Department of Education
REGION IV-A
SCHOOLS DIVISION OFFICE OF CAVITE PROVINCE
Temperature check
Opening Message
Inspirational Message

8:15-9:00 a.m.

(Additional rows may be added if necessary)

XIV. Program Management Team and Terms of Reference

Committee Terms of Reference Members

Executive ● Spearhead the overall Top management

phases of implementation

Program/ Chairperson:
● Prepare all documentary
Planning
requirements such as, but Co-Chairperson:
not limited to, activity
Members:
proposal

● Organize and lead the whole

program flow

● Coordinate duties and

responsibilities of PMT
members

● Prepare Activity
Completion Report
Attendance and Chairperson:
● Prepare and secure the
Certificates
accomplishment of Co-Chairperson:
registration and attendance
Members:
sheets (whether printed or
online)

● Prepare and ensure

dissemination of

Document Reference Code:

DOC-HRD-FR-024

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 Republic of the Philippines
Department of Education
REGION IV-A
SCHOOLS DIVISION OFFICE OF CAVITE PROVINCE
certificates for
participants and PMT
members
Technical Chairperson:
● Collect/ prepare/ assist in
preparation and lead in Co-Chairperson:
playing of audio-visual
Members:
presentations and materials
to be used

● Provide technical assistance

on setting up and managing
the platform to be used for
online/ virtual activities

Documentation Chairperson:
● Prepare/ collect all audio-
visual presentations and Co-Chairperson:
materials to be used during
Members:
the event

● Prepare a narrative or news

report regarding the event

● Assist in accomplishing the

Activity Completion Report

● Create a Drive Folder to save

all photo documentation

Monitoring and Chairperson:

● Prepare QATAME link/ form
Evaluation/
Co-Chairperson:
QATAME
● Consolidate participants’ Members:
evaluation of conducted
activity and identify areas for
improvement

● Provide proponent and all

units concerned with a copy
of the evaluation results with
corresponding

Document Reference Code:

DOC-HRD-FR-024

Revision No.:

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 Republic of the Philippines
Department of Education
REGION IV-A
SCHOOLS DIVISION OFFICE OF CAVITE PROVINCE
recommendations

Safety and Chairperson:

● Secure physical and cyber-
Security
safety and security of the Co-Chairperson:
participants including the
Members:
provision and collection of
Signed Parental Consent
Form if learners are involved
as participants

● Ensure observance of
appropriate health and
safety standards for physical
or face-to-face activities

Officer/s of the ● Manage overall flow of the

Day program for the day
assigned

Food Committee ● Ensure that all attendees Chairperson:

get served with food per
Co-Chairperson:
meal time; coordinate with
the service provider, all Members:
concerns relative to food or
meals

Accommodation ● Arrange for the room Chairperson:

Committee accommodation of all
Co-Chairperson:
attendees; communicate
with the service provider, all Members:
concerns relative to
accommodation; assign,
issue and retrieve room
keys or cards

(Additional committees may be added if necessary)

Prepared by:

<<FULL NAME OF PROPONENT>>

<<Position/ Designation of Proponent>>
<<Contact Number>>
Date: ______________

Document Reference Code:

DOC-HRD-FR-024

Revision No.:

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 Republic of the Philippines
Department of Education
REGION IV-A
SCHOOLS DIVISION OFFICE OF CAVITE PROVINCE

Noted by:1

<<FULL NAME OF PROPONENT’S IMMEDIATE HEAD>>

<<Position/ Designation of Proponent’s Immediate Head/s>>
Date: ______________

Initial Quality Assurance:

__________________
HRD Associates

Quality Assured by:2

RONALYN P. SALAZAR/ CAMILLE R. ORTILLA

SEPS-HRD EPS II-HRD
Date: ______________

MARY ANN B. GATPANDAN

SEPS, Soc Mob and Networking
Date: ______________

MAY ANNE JOY D. ROMANES

SEPS, Planning and Research
Date: _____________

JOSEPHINE MONZAGA
EPS-EsP, CID
Date: ______________

NEIL IVAN P. LONTOC/ LITO CAMO JR.

PDO I, Youth Formation
Date: ______________

Recommending Approval:3

ELPIDIA B. BERGADO DIANA P. TOPACIO

Document Reference Code:

DOC-HRD-FR-024

Revision No.:

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 Republic of the Philippines
Department of Education
REGION IV-A
SCHOOLS DIVISION OFFICE OF CAVITE PROVINCE
Chief, CID Chief, SGOD
Date: ______________ Date: ______________

Acknowledged with allotted budget and resources:4

JOYCE L. MOJICA CHERRY D. BAYOT

Division Budget Officer Division Accountant
Date: ______________ Date: ______________

EDWARD JOEVAN R. ROMEN

Division Supply Officer
Date: ______________

Approved by:

ROMMEL C. BAUTISTA, CESO V

Schools Division Superintendent
Date: _____________

Document Reference Code:

DOC-HRD-FR-024

Revision No.:

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 Republic of the Philippines
Department of Education
REGION IV-A
SCHOOLS DIVISION OFFICE OF CAVITE PROVINCE

NOTES:
1
Applicable for school-level activities only, shall include School Head and PSDS as
immediate heads
2
Signatories for non-Learning and Development activities vary according to the nature of
activity.
a. For educational trips and fund-raising activities, donation drives (Division, District,
school) and other similar activities, MARY ANN B. GATPANDAN, SEPS SocMob
shall be the signatory. If initiated by and for learners, NEIL IVAN P. LONTOC/ LITO
CAMO JR., PDO-Youth Formation and Development must also be included as
signatory.
b. Other culminating activities such as but not limited to school/ District career fairs,
JOSEPHINE MONZAGA, EPS-EsP, as signatories for quality assurance.
c. For research-related activities, include MAY ANNE JOY D. ROMANES, SEPS,
Planning and Research as signatory for quality assurance.
d. For tree planting or in partnership with organizations, include MARY ANN B.
GATPANDAN, SEPS SocMob as signatory.
e. Include Division Accountant as signatory, for schools that utilize Division
downloaded funds and program support funds.
3
Recommending approval signatories must always include DIANA P. TOPACIO, SGOD
Chief. If Curriculum-related or involving teaching personnel, include ELPIDIA B.
BERGADO, CID Chief.

4
If District and/ or school activity, secure approval of District/ School Supply/ Procurement
Officer (if any), Bookkeeper (if any), Disbursing Officer (if any), and/ or Administrative
Officer as counterparts of Division signatories; omit, if not available

Required Attachments:
1. GAD plan for GAD Activities
2. Budget declaration (included in this template; fill up with N/A if no budget needed)
3. Program Matrix (included in this template)
4. List of Program Management Team (included in this template)
5. Session Guide for Training Programs (DOC-HRD-FR-018)
6. CV of Learning Facilitators – for accounting purposes to compute for the hourly rate
of the Speakers
7. For Division Proposals with funding, attach the Activity Request or Authority to
Conduct downloadable from the PMIS.

Document Reference Code:

DOC-HRD-FR-024

Revision No.:

Rev.01
 Republic of the Philippines
Department of Education
REGION IV-A
SCHOOLS DIVISION OFFICE OF CAVITE PROVINCE
8. For needs-based activities, include data on training needs assessment results in the
Rationale and affix copy of the TNA result or findings.

HRD Links:

Purpose Links

Forms, Templates and HRD-related Issuances https://tinyurl.com/HRDFormTemplates

Learning and Development Program and https://tinyurl.com/HRDProposalSubmission

Activity Proposal Submission

Learning and Development Program and https://tinyurl.com/

Activity Completion Report Requirements HRDCompletionReportSubmission

LAC Plan https://tinyurl.com/LACPlanSubmission

LAC Completion Report Requirements https://tinyurl.com/SLAC-PCR

Rewards and Recognition Proposals https://tinyurl.com/R-R-ProposalSubmission

Rewards and Recognition Completion Report https://tinyurl.com/R-R-CompletionReport

Requirements

For Division-initiated Proposals for NEAP- https://tinyurl.com/DREC-EVALUATION

recognition Application

GAD Plan and Budget https://tinyurl.com/School-GADPB

GAD Proposals https://tinyurl.com/GAD-PROPOSALS

GAD Accomplishment Report https://tinyurl.com/GAD-AR-School

Document Reference Code:

DOC-HRD-FR-024

Revision No.:

Rev.01