Republic of the Philippines

Department of Education
REGION X
SCHOOLS DIVISION OF MISAMIS OCCIDENTAL
DISTRICT OF SAPANG DALAGA

ANNEX 1 Research Proposal Application Form and Endorsement of Immediate

Supervisor

A. RESEARCH INFORMATION

RESEARCH TITLE

SHORT DESCRIPTION OF THE RESEARCH

This research will further identify successful strategies, address challenges, and promote
innovation in the Alternative Learning System field through collaborative inquiry and iterative cycles
of reflection and action.

RESEARCH CATEGORY (check only one) RESEARCH AGENDA CATEGORY

(check only one main research theme)
National Region
Schools Division Teaching and Learning
District Child protection
School Human Resource Development
Governance
(check only one) (check up to one cross-cutting theme, if applicable)
Action Research DRRM
Basic Research Gender and Development Inclusive
Education
Others (please specify):
FUND SOURCE AMOUNT
(e.g. BERF, SEF, others)

TOTAL AMOUNT
*indicate also if proponent will use personal funds

B. PROPONENT INFORMATION
LEAD PROPONENT/ INDIVIDUAL PROPONENT

LAST NAME: FIRST NAME: MIDDLE NAME:

BIRTHDATE (MM/DD/YYYY) SEX: POSITION/ DESIGNATION: NO.OF YEARS IN SERVICE:

Male Teacher III

REGION / DIVISION / SCHOOLS (whichever is applicable)

CONTACT NUMBER 1: CONTACT NUMBER 2: EMAIL ADDRESS:

@deped.gov.ph

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 Republic of the Philippines
Department of Education
REGION X
SCHOOLS DIVISION OF MISAMIS OCCIDENTAL
DISTRICT OF SAPANG DALAGA

EDUCATIONAL ATTAINMENT TITLE OF THESIS/ RELATED RESEARCH PROJECT

(DEGREE TITLE)
Enumerate from bachelor’s degree up to
doctorate degree

SIGNATURE OF PROPONENT:

IMMEDIATE SUPERVISOR’S CONFORME

I hereby endorse the attached research proposal. I certify that the proponent/s has/have the capacity to
implement a research study without compromising his/her office functions.

Name and Signature of Immediate Supervisors :

Position/Designation:

Date: