Scribd
Upload
8 views

FORM R.1_PD Program Recognition Application Form_Latest

The document is an application form for the recognition of professional development programs or courses by the National Educators Academy of the Philippines. It requires detailed information about the learning service provider, program profile, course design, funding, and monitoring and evaluation plans. Additionally, it includes a declaration section for the program manager's signature and a list of required attached documents.

Uploaded by

Joan Marie
Copyright
© © All Rights Reserved
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
8 views

FORM R.1_PD Program Recognition Application Form_Latest

The document is an application form for the recognition of professional development programs or courses by the National Educators Academy of the Philippines. It requires detailed information about the learning service provider, program profile, course design, funding, and monitoring and evaluation plans. Additionally, it includes a declaration section for the program manager's signature and a list of required attached documents.

Uploaded by

Joan Marie
Copyright
© © All Rights Reserved
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
You are on page 1/ 6

Republic of the Philippines

Department of Education

National Educators Academy of the Philippines

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 NEAP

Complete Office Address


Contact Person Mobile No. 09387402340
Telephone No. Email Address [email protected]
NEAP Authorization Number For Authorized Learning Service Provider only.

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
2
Rationale
100-150 minimum words
(Provide a brief description of the program. State the Terminal Objective/s and Enabling Objective/s of the
program by referring to what participants will gain in terms of their professional knowledge, professional
practice and/or professional engagement. Objectives should follow the SMART principle.)

3 Terminal Objective
Program Description

Enabling Objectives

4
Professional Development (State the DepEd Professional Development Priorities this program covered or DM 50 s. 2020 and/or other e
Priorities
6
(Indicate Position Title and and or whether beginning, proficient, or PRC Program (For Non-DepEd
5
Target Participant highly proficient teachers. Include target number of participants by Accreditation LSPs)
gender) No.
7
Delivery Platform Face to Face 8
Date From Start Date to End Date

COURSE LIST
Learning Service Providers can attach one or more courses in a program for recognition. You are required to list courses you are applying
for recognition in the table below and then provide a detailed description of each course on the COURSE DESIGN page.
9 10 11 12 13
Course Title Professional Standards Covered Schedule Modality
1
2
3

Professional Development Programs/Courses Recognition Application Form Page 2


Add more rows to add courses.

Professional Development Programs/Courses Recognition Application Form Page 3


COURSE DESIGN
Provide a detailed description of each of the courses by breaking it into discrete sessions/modules. You may create a copy of this page if
you have two or more courses.
14
Course Title Cluster-Based Robotics Training Workshop
15 Teachers will be acquainted and informed on how to design and create simple robots that will help them in lectures
Course Description
technology advancement.
22
18 20 Resource
16 17 Session 19 Assessment 21
Duration Topic Methodology Outputs Person/ Learning
Objectives Strategies
Facilitator
1
2
3 As
4
5

Add more rows to add sessions.

PROGRAM IMPLEMENTATION PLAN


23 24
Funding Source Budget Provide
SDO MOOE Requirement details on how
Professional Development Programs/Courses Recognition Application Form Page 4
How will the funds will
the be allocated.
program If registration,
be funded? how much will
To include be collected in
the Work s each course?
Financial Use
Plan attached
budget
estimate
template as
reference.

Monitoring and Evaluation Plan


This is a sample M and E Plan following the Kirkpatrick Evaluation Model, if you have an existing M and E Plan you may use that instead.

Levels of M and Methods and Schedule of M User of M and E


Indicators Data Sources Person/s Responsible Resources
E Tools and E Data
25
Results What will What Who and/or When will M Who will be What Who will use the
be methods/tool what and E accountable for resources are data gathered?
measured s will be documents activities be ensuring that M and E needed to
? used to will provide undertaken? activities are done? implement M
collect data? data or and E
evidence on activities?
the
indicators?
26
Behavior Type here. Type here. Type here. Type here. Type here. Type here. Type here.
27
Learning Type here. Type here. Type here. Type here. Type here. Type here. Type here.
28
Reaction Type here. Type here. Type here. Type here. Type here. Type here. Type here.

Professional Development Programs/Courses Recognition Application Form Page 5


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.

Sign off by the Program/Course Manager or its equivalent


Program Manager Type here
Signature
Date Click here to enter a date.
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
Monitoring and Evaluation Plan

Professional Development Programs/Courses Recognition Application Form Page 6

You might also like