Republic of the Philippines

Department of Education

FORM R.1 Professional Development Program/Course Recognition Application Form

INSTRUCTIONS: Input the necessary details. Indicate N/A if not applicable. DO NOT ABBREVIATE.

LEARNING SERVICE PROVIDER PROFILE

Learning Service Provider AMONTAY ELEMENTARY SCHOOL
COMPLETE OFFICE
BARANGAY AMONTAY, BINALBAGAN, NEGROS OCCIDENTAL
ADDRESS
Contact Person MICAH R. TABANO Mobile No. 09452978897
Telephone No. NONE Email Address micah.rotas@deped.gov.ph
NEAP Authorization Number N/A
National Educators Academy of the Philippines

Version April 2021 Page 1

PROGRAM PROFILE
You will need to complete the following components to describe the program you would like to be recognized.
1
Title CRAFTING SUMMATIVE TEST WITH TABLE OF SPECIFICATION (TOS)

The LAC session about Crafting Summative Test with TOS will engage all teachers of Amontay
2 Elementary School in a one (1) day workshop that will increase in-depth knowledge of preparing a
Rationale
test with Table of Specifications (TOS), and improve the validity of teacher’s evaluations based on a
given assessment.
100-150 minimum words
Terminal Objectives:
By the end of the LAC session, participants will be able to:
3
Program Description
1. Deepen their understanding in preparing a Table of Specification; and
2. Prepare sample classroom test specification or blue print for the evaluation of pupil’s
performance.
4 Domain 5: Assessment and Reporting
Professional Development
PPST Strand 5.1: Design, Selection, Organization and Utilization of Assessment Strategies
Priorities
The target participants are the following: (For Non-DepEd
LSPs)
Level Position Male Female Total
6
Highly T- 2 0 1 1 PRC Program
5
Target Participant Proficient T- 1 0 5 5 Accreditation
Teachers No.

Proficient T- 1 0 3 3
Teachers
7
Modality Face- to- Face 8
Indicative Date of Implementation November 24, 2023

LIST OF TOPICS

9 10 11 12 13
Course Title Professional Standards Covered Schedule Modality

Professional Development Programs/Courses Recognition Application Form Page 2

 Domain 5: Assessment and Reporting November 24, 2023 Face- to- Face
CRAFTING SUMMATIVE PPST Strand 5.1: Design, Selection, Organization and 8:00- 5:30 PM
1 TEST WITH TABLE OF Utilization of Assessment Strategies
SPECIFICATION (TOS)

ACTIVITY DESIGN
Provide a detailed description of each of the topics.
14
Activity Title
15
Course Description Provide a brief description of the activity.
22
18 20 Resource
16 17 Session 19 Assessment 21
Duration Topic Methodology Outputs Person/ Learning
Objectives Strategies
Facilitator
1 2 HOURS Revised Bloom’s Give teachers an This will be conducted in face- pretest and Personal MARNELLE S.
Taxonomy: opportunity to to- face modality with invited posttest activity Journal UCAG
Pathway to learn and speaker to explain the topic will be given to (List down 3
Improve practice a range using PowerPoint Presentation. the participants most effective
Thinking of thinking and Various activities will be to evaluate their strategy that
provide a simple provided to the participants. learnings in the you use in
structure for topic. A teaching your
many different monitoring and class)
kinds of evaluation tool
questions. will also be
utilized by the
participants
2 2 HOURS The Knowledge Update This will be conducted in face- pretest and Formative and KIMBERLY R.
and Cognitive teacher’s to- face modality with assigned posttest activity Summative ABRIGO
Process knowledge and learning facilitator to explain will be given to Assessment
Dimensions understanding the topic using PowerPoint the participants
Presentation. Various activities to evaluate their
on the kind of
will be provided to the learnings in the
knowledge to participants. topic. A
be learned and monitoring and
the process evaluation tool
Professional Development Programs/Courses Recognition Application Form Page 3
 that will be will also be
used in a utilized by the
classroom set participants
up.
3 4 HOURS How to Ensure that the This will be conducted in face- pretest and Summative ROAN C.
Construct Table teacher has to to- face modality with assigned posttest activity Test with TOS GASALAO
of Specification cover all topics learning facilitator to explain will be given to
listed/budgeted the topic using PowerPoint the participants
in the grading Presentation. Various activities to evaluate their
period. will be provided to the learnings in the
participants. topic. A
monitoring and
evaluation tool
will also be
utilized by the
participants
Add more rows to add sessions.

Declaration:

I hereby declare the information provided in this application is true and correct and there have been no misleading statements,
omission of any relevant facts nor any misinterpretation made.

I agree that the DepEd-National Educators Academy of the Philippines to be the co-owner of all the data gathered and the
copyright of any publication of the use of these data.

Professional Development Programs/Courses Recognition Application Form Page 4

Sign off by the Program/Course Manager or its equivalent
Program Manager ROSE ANN PIE O. DORIMAN
Signature
Date November 26, 2023
This Form R.1 is not valid if not signed.

Required Attached Documents:

Detailed Course Design

Sample Learning Resources (Modules, Worksheets, etc.)
Sample Session Guides
Sample Assessment Tools
CVs of Primary, Secondary, or Alternate Resource Persons
Budget Estimate Form

Professional Development Programs/Courses Recognition Application Form Page 5