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riRepublic of the PhilippinesDepartment of Education
Region lV-A CALABARZONCITY SCHOOLS DIVISION OF CABUYAO
MEMORANDUM
TO
FROM
SUBJECT
DATE
OIC - Assistant $chools Division $uperintendentChief, Curriculum lmplementation DivieionCItC - Chief, School Gcvernance and Operations DivisionEducation Program SupervisorsPublic Schoo{s District SupervisorsFublic Elemeniary, $econdary and $enior High School HeadsPublic Elennentary, Secondary and Senior High School TeachersAll Others Concerne{
.M{wd*,.Officer-ln-ChargeSchools Division Superintendent
20 I I fin ETROBAI.IX FOU f't OATION O UTSTAfII Dl NGFILIPINOS.AIfUAft S FOR TEACHERS
February 2?,201&
1. Relative to the DepEd fulernorandum No. 003, s. 201S re: 2018 MetrobankFoundation Outstanding Filipinos Award for Teachers, this office encouragesqualified applicants from this division to join the ?018 Metrobank Foundation
Out*tanding Filipinos - Award for Teachers.
2" The award aims to recogniee outstanding Filipinos who are respnsiblecitizens, exemplary pubiic servants, and agents of positive change in theirrespective communities.
3. Mechanics, procedure$, aftd guidetines for the nomination are stipulaied onthe attached DepEd Memorandurn.
4. Nominees must fill out online nomination form, and submit duly accomplishednomlnation form (either handwrifren, or filled out online, printed and signed) andcomplete supporting documents on CIr before March 1,2A18 through courier toMetrobank Foundation, 4h Floor, Executive Offices, Metrobank Plaza, Sen. Gil J.Puyat Avenue, Makati City. The online form is available through the websiteaddress: www.mbfaundatian,org"eom or at official facebook page:www.f a ceboo k. co m/ mbf. ou&tan di n gfil i pi n as.
5. For msre infsr'matisn, contact Ms. Kristal Todcor, Metrsbank FoundationOutstanding Filipinos-Award for Teachers Secretariat, at telephone no. {02,1898-8757, mobile phone nos. 0925-830-3717 ar 0977-723-6?05, or email atoufstandfi gfi I i pi n os. m bf i@ ma il.cam or kristal.todcor!&netrobank.cam.ph
5. lmmediaie and wide dissemination of this mernorandum is desired.
-
sso d/mo p/t bd/ 0221 18 llI
Republir of tfie {il_ttippitttr
Bessrtmeilt of @Iutstton
,17 JAN 201$
Deptrd MEMORANDUMNo. 00 3 s. 2ct18
2018 METROBAI{K F'OUNDA?IO$ OUTSTAI{DING FILIPINOS -AII'ARD FOR TEAC}IERS
To: UndersecretariesAssistant SecretariesBureau and Service DirectorsRegionai l)irectorsSchools Division SuperintendentsPutrlic and Private Elementary ancl Seccndary- School HeadsA1l Ottrers Concerned
1. The Metrobank Foundation Inc" {MBFI}, in cr:operation q.ith the Department *fllelucation {DepEd}, announces the launching of the 20tr8 Metrobank FoundationOutstanding Filiptnos - Award for Teachers. Now on its 34tlr year, the lrortndationha.s aw'arded a total of 360 teachers from public and private schools all over thecountry, bestowing honor upon the teaching profession by according specialrecognition to those who render service abor.e and beyond the cail of clutv.
2. The arvard aims to recognize outstanding Filipinos w*ro are responsiLrle citizens,exempiary pub'lic servants, and agents of positive change in their respectivecornmunities.
3. It is open to teachers who are Filipino citizens teaching in the elementary
{ineluding kinciergarten level, provided it is part of the integraterl curriculum or partof an elementary school system), secondary or tertiary levei, inclrrding gracluate schoolancl alternative learning system. with full-time or permanent appointment and withfull teaching load.
4. Nominees must have been actively teaching in the Philippines for the last tetry'eilrs {inclusive of leaves not exceeding three years* prorrided that the nominee isteaching at the tirne of nominationi. Teachers rlrho are on official or sabbatical leave
during the time of nomination are still quali{ied; however, they rnust sti11 have at leaslthree remaining years of sen,ice before retirement.
5. Nominees must have at least cornpleted academic requirements for Master'sDegree for both elementary and secondary categories.
6. Nominees must have average performance ratings of at least Verg Satis/actoryllor the past ten )'eat:s in teaching. For those ,*,ho have been on official/sturly leave oron seconclment, performance ratings for ten years closest to the period of nominationshould be provided.
f)epErl comptex, Meralco Avenue, I,asig City ,arrro ,Srraa-72081633,72 '28/632'rao, S 63{r-487r;i ri.i?-uruu { rl-lvrv.dt'per1.gor'ph
7. Nominees rnust NOT have been ad.judgecl guilty in any administrative, civil, orcriminal case.
8. Nominees for the elementarr and secondary categories must have valiri licenseas a teacher from the Professional Regulation Commissieir:.
{}" Nominees must }:e officially norninatect b-y t}:e schooi principals orteachers-i.n-charge {TICs). if the nominee is the TIC, the Public Schoois DistrictSupen'isor must endorse the nomination. Fr:r DepEd schools without principals, tireTIC may nominate but the schools rlii..ision superintendent (SDS) must endorse thenomination. Official nominees in the elementary and seccndary categories of satellitecarlpuses of private colleges a;:d ur:iversities, and state universities and coileges{SUCs} r.r,hich are not autonomous, may be nominated by ihe Carnpus Directors orExecutive Directors, but the Presidents are stili the official nominators" lJponinrritation by the award secretar-iat, selected indivicluals arrd reputable organizationsma-v nominate a candidate of their choice.
tO. Elementary school heads are entitled to nominate two teachers: one for primary{Kindergarten to Grade 3} ancl another for intermediate (Grades 4 to 6} level, whiie higirschool heads are entitled to norninate only cne teacher.
1L Nominees must Lre officiall-v nominated by a qualifred nominator to be consicleredfor the award. Self-nomination shall not be accepted nor cnnsidererl. Nominees mustalsr: fiI1 out the r"rnline nominaticn fr:rm, Ai{D sutrmit the duly accr:rnplishednomination form {eit}ier handrr,'ritten, or filled out online, printed and signed} andcomplete srrpporting documents on or before March 1, 2018 through courier toMetrobank Founclation, 4th F'loor, Executive Offices, Metrobank Plaza, Sen. Gil .j.Fuyat Avenue, Makati City. The online form is available through therr"'ebsite address: wunp,mbfoundation.org.ph or at the official Filr:ebook page:www"facebook.corn/mbli,outstandinglilipinos. Earl.y sutimission *f nominaticnforrns and supporting documents is strongl;, encouraged for faster a$ses$menr.
1"2" The following are the enclosures required to complete the nomination:
Enclosure No. 1 - Nomination Form,Enclosure No" 2 - Affidavit of Understanding,Enclosure No. 3 - Guidelines in Freparing the Supporting Docurnents,Enclosure No. 4 - Guidelines in Writing the Milestone Accornplishrnents, andEnclosure No. 5 - Template on Milestone Accomplishments.
13. Winners of either local awards for outstanding teachers are encourageci to join,provided the eligibility requirements are met.
14. As the Metrobank Foundation Outstanding Filipinos is onl.y on its seconcl -vear ofirnplementation, ali past regional and national frnarlists under the fo{etrobankFoundation Search frrr Outstanding Teachers {SOT} may still join, subject tci eiigiirilityrequirements.
15. Irour awardees shali receive a medal, trophy, and a cash incentive ofP1,000,00O.00, part of which will be allocated to the faculty development project,subject to the approved proposal of the endorsing school. Each of the national finalistsrviil receir,e PSO,00O.0O.
16. For more information, contact Ms. Kristal Todcor, Metrohank Foun<latir:nOutst:rnding Filipinos-Award for Teachers Secreta-riat, 4th Flcor, Executive Clflices,Metrob:rnk Plaza., Sen. Gil J. Puyat Avenue, Makati City, at telephone no"
{O2) 898-3757, n-robile phone nos" 0925-830-3717 ar A977-723-6205, or ernail atoutstandingfilipinos.mbfit4grnail.crrm or kristal.todco(@metrobank"com.ph.
17 " Irnmediate dissemination of this Memorandurn is desired.
{a-r,FLEOITOR IfiAGT€'LIS BRIONES
Secretar!,
E n-lr.
As stilted
Reference:DepEd Memorandum No. 21, s. 2AL6
To be indicated in the Perpetual Ilrdexunder the following subjects:
OFFICIALSPRIZES OR AII/ARDSStrARCI{TEACHERS
IIJP, DM 20 1 s slglq{)bapk&''i]rdes!)]tqilslC4d1llC-ftbptnsg-- Awa4llarla!!&giI 1 26-Ilec. 20 / 2l / 29, 2417
Fnclosure to No. 1 to Deptrd Memorandum No. 0C3, s. 2O18i
3'! &{etrobank Foundetien
L-ir;-r-s"i-nru ilii\( ;
FrrrruNoS
I nstructionsr1. Please fill out all information completely and legibly. Use black ink or encode in the computer.
Wrlte NIA if necessary.
2. Submit original copy of the ACCOMPLISHED nomination form together with the COMPLETE
supporting documents (see attached GuLdelines in Preparinq SuppartinLDocuments, Guideljnes
in Writina Milestane tklplnplbhntenls, Template s!-Milestone Accomplishments, and Affidoujlof Und?EsLing) through courier on or before March 1, 2018. Address it to MBFI-OF, N4etrobank
Foundation, 4/F Executive Offices, Metrobank Plaza, Sen. Gil Puyat Ave", Makati City ]2gg'3. To CCMFLETE your application, please accomplish the online nomination form. The link will be
available at :j.':n::,1*:t.l:,r,:-,j.j.,1..:,:i;...,;i:- or at the official Facebook page of N4etrobank
Fou ndation Outstanding Filipinos (€}mbfi.outstandi ngfilipinos).
j
$iil
Category Joining in: /please check one)
iJ Elementary Primary Levels {Kindergarten to Grade Threei | [ Secondary Level {Grade Seven to Grade Tweive}
I tlementarylntermediateLevelsicradeFourtoGradeSix; iI-l uigherEducat;on/Graduateschool
AWARD FOR TEACHERS
hr s tu{ il{ AT r0 N t 0 a el1
FORM 1
Attach here your latesl 2"x?" lDpholo. lt must be fronl,
facial close*p, with your printed
name & signalure at the back o{
the photo.
I
IIL-
I. PERSONAL INFORMATION
FullNarre: (Mr./Mrs.lMs./Dr.l(Please encircle)
Home Address:
First Nanre Middle Name Last Name
Residence No Street Su bd ivisionlDistrict/town/Ba rangay
CirylMu n icipality Province
Place of Birth:
Zip Code Regir:n
Date of Birth:!nry,ldd/.vyi
Gender: I M
Name of Spouse:
Age: Religion
tl F Civil Status: {3 Single E Married I Legally Separated tJ Others {pts. specify)
No. of Children
Alternate Emaii Add:
Citizenship:
Active Emaii .Address
Residence Phone No.:iAres Code + Telephane No.)
Personal Mobile No.;
H. PROFESSIONAL INFORMATION
PRC License Number:
Date Entered Teaching
CurrentBank:
Valid until TIN No:
Current PositionlDesignation:Ccmplete School
Mailing Address:
Total Years Teaching:
lConsoliddled expetie$ce]Bemaining Years in Service:i3efors reairetr)entj
Subject Specialization:lTeaching naw)
GradelYear Level
being handled;
Sr:hocl Name:
No./Street District/town/Barangay
City/M u nicipality
Office Phone No.:{Aten CadE +T.tephcre No.i
Province
Office Fax No.:iAteil bCe + feieph1ae !,jo.)
Zip Code
Office Emaii Address;
Region
Your Schoolllnstituiion's Deflnition of Fuil Load:For Elementary and Secondary'. indicale no. of ltaurs Der weekFor Higher Education: indicate no. af ustt tards per tqrtn Qr aa,
Your actual teaching load for schocl year 201 7-201 B:
Page 1 of lt
iFnciosure to No. I to Deptrd N{emorandum No. fi03, s. 2018)
1$! ttlerroEank Foundalirn
f)t ;-l-\Tnr.- i)l N{ ;
F mtrt r\i*S
lnstructionsr1,. Please fill cut ali information completely and legibly. Use black ink or encr:de in the computer
Write N/A if necessary.
2" Submit original copy of the ACCOMPLISHED nomination form together with the COMPLETE
supportrng ciocuments (see attached GpLdelines in Preparinq Su#pafttnq Dac-uments, Gutdelines
tn l,VltjnLMilestone Accolrplj,blnEllg Template an Milestan and ffilgvi!of lLndertakinq)throughcourieronorbeforeMarchl,20lS. AddressittoMBFl-OF,l\{etrobankFoundation, 4lF Executive Offices, Metrobank Plaza, 5en, Gil puyat Ave^, Makati CitY 1200.
3. To COMPLETE your application, piease accornplish the onl.lne gominatiqn lerm. The link will be
available at :-::-!r..=r:rl:-1,::.rji,l:,:1,,]:::r,-.,jL sr at the official Facebook page of Metrobank
Foundation Outstanding Fiiipi nos {@mbfi.outsta ndingfilipinos}.
AWARD FOR TEACHERS
hlOMINATIOl'l IORfu1
FORM T.
Attach here yoLrr latesl 2"x2" lDphoto. lt must be {ront,
facial close-up, with your printed
name & signalure at the back oithe photo.
a
TILIi
Category Joiningin: {please check one}
i3 ElementaryPrimaryLevels{KindergartentoGradeThree} lil SecondaryLevel {GradeSeventoGradeTwelve}
if tlementary lnterr.nediate Levels iGrade Four to Grade Sixi I I-i Higt,ler Iducation / Graduate School
t. PERSONAL INFORMATION
FullName: (Mr./Mrs./Ms./Dr.)(Please encircle)
Home Address:
First Name Middle Name Last Name
Residence No Street Subdivision/District|l own/Barangay
CitylM u nicipalitV
Age
Province
Place of Birth: Religion;
il F Civil Status: i.l Single E Married I Legally Separated ;] Others {pts. specifyl
No. of Children:
Alternate Emaii Add
Zip Code Region
Date of Birth:t*n/dd/y.yi
Gentler: J M
Narne of Spouse:
Citizenship:
Active Emaii .Address;
Residence Phone No.:!,*eo Code + Telephane No.)
Personal Mobile No.:
n. PROFESSIONAL I N FORMATION
FRC License Number:
Dat€ Entered Teaching:
CurrentBank:
Valid until: TIN No:
Current PositionlDesi6naticn:Complete SrhoolMailing Address:
Total Years Teaching;
{Consolidated expetience )
Remaining Year's in ServiceEerore rst/reir1eilt)
Subject Specialization:(Teoching ndw)
Grade/Year Levei
being handled:
Schocl Name:
No.lstr€et Districtflown./Ba rangay
Ciiy/Mu nicipality
0ffice Phone No.:{Arrt, a6de t lelephone No.)
Province
Office Fax No.:!Arcil l.iie + f eit'nhcne Na.)
Zip Code
0ffice Email Address:
Region
Your Schoolllnstitu{ion's Definition of Fuil Load:For Elementary and Secondary'. indicate ao. of hours Per wee*For Higher Education: indicate no. of uait load1 per rer,fl (u na. o{ contact haurs pJ:{ tern
Your actual teaching load for schoal year 2A17-2018.
Page 1 of 4
,I
(i.e. HS Grad, College Grad, etc)NAME & ADDRESS OF SCHOOL
NAME & ADDRESS OF SCHOOL
IV.PE RFORMANCE EVATUATIONWrite your pe$armance evaluatian/rating obtained for the last ten {1A) years in teaching.
V, COMPETITION RECORDHave you joined the Metrobank Foundatiorr Outstanding Filipinos -Award fcrTeachers {formerly SOT} before?
fvrs [ ruo
lf Yes, in what yearls?
Have you been a Flnalist of the Metrobank toundation OutstandingFiiipinos - Award for Teachers (formerly SOT) before?
Ivrs [ ruo
lf Yes, in what year/s?
VI.CRIMINAL, CIVIL & ADMINISTRATIVE RECORD
Have you been CONVICTED of any of the following offenses at qnltime before you ioined and/oduringactive in service?
* Administrative ll Civil I criminal
-YES _ NO
Status: iJ Case Dismissed d Pending
Have you been CHARGED with any of th€ following offenses at anylEinebefqlgl{eu ioined andlor during active in service?
il Administrative D Civil tr Criminal
_YES _ NO
Statusi Li Case Dismissed U Pending
Vll. ENDORSEMENT {ta be filled out dnd signed by the naminntar}
On a separate sheet, please explain why the nominee should receive the Metrobank Foundation Outstanding Filipinos - Award for Teachers. Please
touch r:n the following areas: personal character, instructional compeience and teaching effectiveness, and professional and ccmmunity involvement.
Please cite specif;c examples.
lPlease attoch the endorsement ta the duly accomplished nominatian Jorm upon submission.)
III. EDUCATIONAL BACKGROUND & ADVANCEMENTrvith lie rrost
For nominees who have been CHARGED or CONVICTED with criminal, civil, or administrative offense, plrase submit a short report which include
the following: {Please include a report even if the case has been dismissed or amicably settled in your supporting documents)
al Case number and nature of charge (libel, estafa, physical abuse, etc.)b) Date the charge was filedc) Where the charge was filed {City / Municipal I RegionalTrial Court)
d) Circumstances surrounding the complainteJ Status/Final Resolution ipending I on-going, amicably settleci. dismissetl, etc.)
Page 2 of 4
MAJOR /SPECIALIZATION
INCLUSIVE
YEARS
,ACADEMIC
DISTINCTIONS
Coursesf Degrees Being PursuedMAJOR /
SPECIAI-IZATION
INCLUSIVE
YEARS
UNITS EARITIED /STATUS
School Years.Y.
2007-2008
s.Y.
208&2009
s.Y.2009-2010
s.Y.2078-2011
s.Y.2011-2012
s.Y.20L2-2013
s.Y.2013-2014
s-Y.
2414-2015
s.Y.2015-2016
g.Y.
2{r16-?(}1?
Numerical Rating
Bescriptive Equivalent
Thrs s to certify that I voluntariiy nominate to the 2O18 Metrobank Foundation OutstandingFilipinos - Award {or Teachers. This nomination is a tribute to his/her track record of excellence in the teaehing profession and to hisi/her exemplarydedi.ation to ths cail to help shape the future of our youth and ultimately contribuie to national develoomerrt-
Signed this day of
Name of Building / No. St!.e€t
City/Mu n icipality
Office Phone No.:iA{ed Cade + Tplephofie I'ia.)
Province
Personal Mobile No.
1 also certify that I am physicaily and rnentaliy fit to undergo the evaluation process of the Search. Further, I authorize the organizers of the searchor their designated agent/s to validate the lnformation, records, documents that I shall submit in relation to the nomination and to use these inrelated activities. in this regard, I hereby exernpt, discharge, release and free Metrobank, the t\/etrobank Foundation, Inc., their respectrvedirectors/trustees, officers, employees, members and staff, affiliates and/or subsidiaries, and the jurjges i:f the search, from anrT claim or liabilityarising from my participation in the search.
I hereby certify to the best of rny knowledge and helief that aii the information contained in this form is yue and correct. I arn aware that any willfulrnisfepresentation or misdeclaration of facts or any untruthfui statement or information stated herein shali be used as basis for my disqualification orthe withdrawal of any award slot.
I hereby commit that should i win in the search, I wiil continue to render service in the philippines for at least three (3) years.
Printed Name and Signature of Nominee
This is lo cerlify that I voluntarily submit myseif to the rules of the Metrobank Foundation outstanding Filipinos - Award for Teachers. I aqreglq
Please list down three {3} names of references that are not directly related to the nominee,
Page 3 of 4
Date{mm/dd/yy} DI:.-
Designation:
Printed Narne and Signature of Nonrinator
Affiliation:
Zip Code
Personal ImailAddress:
Signed this day 0fDite{mm/dd/!vl Place
NAME POStTION/OR6ANt ZATTON ADDRTSS MOEILE NUMBEREMAIL
ADDRESS
!.
2.
3.
DATES Tg REMEMBER
.! March 1,2018Deadline for Submission of accomplished and signed Nomination Form and complete SupportingDocuments
Preliminary and Final Judging
Annou ncernent of Winners
Awarding Ceremony
Metrobank Foundation Outstanding Filipinos-Award forTeachers Secretariat, 4'" Floor, Metrobank Plaza, Sen- Gil Puyat
Ave., Makati City, Philippines 1200
Page 4 of 4
* April- july 2018
.l August 2018
+ September 2018
WRITE U5:
EMAIL US: outstandinefilioinos.mbfi@emai l.com ; kristal.todcar@me!rqbank.com.ph
CALL US:clo Ms. KristalTodcorDirect line: i02) 898-8?57M obiie N urnber: {0925 I 83a-31 i7 I ta9l7 i7236205
iEi-rclosure to No. 2 to DepEd fuIemorandum No. 003, s. 20i8)
REPUBLIC OF THE PHILIPPINES ]] S-S,
AFFIDAVIT OF UNDERTAKTNG
af legal age, singlelmarriedlrAiidowlseparated,Filipino and residing at after having been dulysworn to in accordance with law, do hereby depose and state that:
1". I am joining the 2018 Metrobank Foundation Outstanding Filipinos and in connection therewith, Iam submitting my duly accomplished nornination form and the required supporting documents;
2. I hereby attest to the best of my knowledge that all the information contained in the nominationform and documents is true, accurate and correct;
3. I also affirnr and attest that i am of good moral character and have not violated any laws of theland {including the Civil Codei at any tinre before or during the period I joined the teachingprofession;
4. I have read and will abide by the rules, regulations and requirements governing the above-mentioned competition ;
5, I am aware that any willful misrepresentation or misdeclaration of facts stated herein or in thenomination farm and/or supporting documents can be used as basis for my disqualification fron'rthe award; and
6. I arn executing thls affidavit to attest to the truth, veracity and validity of ali the foregoing and tocertify, under aath, the authenticity of my records, under pain of perjury,
FURT}IE& AFFIANT SAYETH NAUGHT
Affiant
RTPUBLIC OF THE PHILIPPINES
} S.S,
SUBSCRiBED AND SWORN TO before me this day of Z0_, inaffiant exhibiting hislher Community Tax Certificate No.
Issued at
Page 1 of 1
ZA
t,
lEnciosure to No. 3Xp! tterrobank Foundaginn
L)i trl,\\t)tN(;F tt_im Nt)S
Mernorandum No. 003, s. 2018)to llepEdDOCUMENT 1
GUIDELINES IN PREPARINGTHE SUPPORTING DOCUMENTS
IMPORTANT:L. Kindly read the instructions carefully. lt is important that you fill-out all the requested information. Failure to comply may be a
ground for disqualification.Z. Note that there are supporting documents to be submitted as hard copy and others to be submitted as electronicfxanned/digital
copies only (Pleose reJer ta the instructians for each sectian\.
3. ALL documents submitted as hardcopy should also be raved in WORD format and in PDF format which should be placed in a
compact disc (CD) or Universal Serial Bus {USB}, and properly labeled with your name and schoollunit.
4. Please use long bond paper (8"x13") with L" margin on all sides. Use Arial font, size 1.2.
5. Please make sure that all documents requested, as indicated in this form, are included. STRICTLY ARRANGE THE DOCUMENTS AS
THEY ARE LISTED BELO\tr.
6. Documents/certifications should NOT appear twice across several eriteria or sections.
7. Notarized affidavits can i:e submitted in case the documents/certificates are unavailabie.
L Please keep within the prescribed number of pages.
9. DeaCIine for submission cf Nornination Form arrd complete supporting documents is on or before MARCH 1, 2018 to Metrsbar.rk
Foundation office, 4F Executive Offices, Metrobank Plaza,Sen. Gil Puyat Ave., Makati City 1200.
I. NOMINATION FORMSubmit original copy of the ACCOMPLISHED nomination form together with the COMFLETE supporting
documents listed beiow through courier on or before March 1, 2018.
NOM INATOR'S ENDORSEMENTSubmit a description of the nominee written & signed by the nominator. PIease explain why the nominee
should receive the Metrobank Foundation Outstanding Filipinos,Award. Piease describe the nominee in terms
of the foliowing and cite specific examples:
a) charaeter (personal qualities)h) competence iprofessional skills, expertise and track recordi
c) community involvement
* -PAc;ri
lnn"e{rn-gn)4 pages
7 page
II" PTRFORMANCE RATIN6 CERTIFICATION
Submit a certification of the summary of performance evaluatian,/ratings obtained for the last ten {10) years,
:,xg!S[ngthe current schocri year, Please indicate both the numerical and the descriptive equivalent oftherating scale being used. For example, a rating of 85% means "VerV Satisfactory" or {VS). For those on leave for a
specific period, please olltain certification from head of schopl that nominee has been on studY / official leave.
Provide ratings of previous year/s to complete the 10 years requirement,
1 Page
TATEST PERFORMANCE EVATUATION SHEET {or accomplished and signed lndividual Ferformance 2 paEes
Commitment and Revlew Form)
IV" PERSOIUAL QUATITIES AND PROFESSIONAL CAREER INFORMATION
A. EDUCATIONAL ATTAINM ENT
A.7 Fsrmal Educstion! i.submitacertifiedtruecopyoftranscript/sofrecordsanddioloma/sforthehighestdegree/siwiththeschool i
!j] seal) attained and/or for the degree/s being pursued. *-*-==-:
;;-*-l-lI
1" page
Na limit tona. of pages
i1
.'..'.-....*.---,----.-l
FORMAT:HARDCOPY DOCUMENT E LECI R A M Cl S€AN N E D / D t 6 trA L CA PY
r' Copies should be clear and legible../ Provide a table ofcontents with the corresponding sections.
You may include sub-headings, short descriptions and
summaries, when necessary..r' DO NOT USE CLEAR BOOKS. BIND your documents with the
following coior covers:
TEACHERS SotDtERS POLICE OFFICERS
Kinder to G3: PA: PCO: dark blue
Grades 4-6: vi*let PN: white PNCO:
Secondary: PAF: blueHigher [d:yellow
,/ Do not submit books, thesis or VCDs.
J All electronic/digitaUscanned flles that are required as
Evidence for each Cocument section should be saved in
PDF format {optimized for print quaiity)" Photos shouid
be saved as IPG oTJPEG format {with 150 dpi resoiution,
actual size,}.
,/ All electrcnic,/scanned/digital files should be arranged
according to their respective sectiens and saved in a CD
or US$,/flash drive labeled with your full name and
schooUunit to be eirclosed together urith the hard ccpy.
III. NGTARIZED AFFIDAVTT OF UNDERTAKINGSubmit a Notarized Affidavit of Undertaki
Page 1 of 5
DOCUMENT SECTIONSIPAGE NAME
2. For Elementary and Secondary Teachers: Submit a Cartification of Completed Academic Requirements from
CollegelUniversity signed by the Registrar for nominees who have yet to complete their Masters Degree ^
For Higher Education Teachers: lnclude Di6|TAL OR SCANNED Ccver Title / Topic of Dissertation Paper for
Doctorate Degrees.
A.2 Certified l-ist of Courses and/ar Reloted Trainings/Shert tourset Fo€ilftafedList down a rnaximum of ten {1.0} ma.lor training programslshort courses hjjliglCd&ondu*Sd by the nominee
Mention the specific role an any special citation received after the traininglshort .ourse,
couRsE I TRATNING0RGANTZATION /
LOCATION
tNeLust\lgDATTS
INCLUSIVE
DATEREMARKS
tuo limii lona. a! poges
2 pages
2 pages
I page
2 p6ges
2 poges
DICITALISCANNED COPIE$ REQUIREB:
Sconned certi, related tfii. ha rt c au r se s f a ci litate C /ca nd u cte d
A.3 Certilied Li,'sr of Courses and/or Relqted Trainings/$fiorf Courses Cornpleted/AttendedList Cown a maximum of ten {10} advanqed training programs, seminars, workshops, or short courses attended
by the nominee (e.g. internationally-sponsored traininglsponsored by the national government or professional
associations/ DepEd/ CHED/AFpIPNP-approved in-service ;cholarship or training). Mention any special citation
received after the traini ort course.
COURSE I TRAININGoRGANTZATION I
LOCATION
}NCLUSIVE
DATES
COMFLETTS
{YINiREMARKS
DIGITAL/SCANNED COPIES BEQUIRED:
Scsnned certilicates ar enidence af reloted traintn caurses ottended.
8. SERVICE PERFORMANCE
8.7. Certified List af Positionsy'RanksList down all the positions and ranks held in the entire career as a teacher, police, or soldier. Start from the most
recent.
8.2- tertilied List of Service/Prafessional Awards receivedl-ist down a maximum of ten {10} best ser,rice- / professional-related awards for teacherslpolice officers/soldiers
receivedbythenomineeintheentirecareer. Listoiawardsshouldbearrangedaccordingtoimportance
{highest to lowest}.
NATE: Far teachers, DO NOT include awords won by students who were trained by the naminee {e.9. First Ploce
in {ditorial Writing, NS7C/STEP, etc.) or certificotes af appreciatian.
PROEESSIoffAL AWARDS
TffLE / CITATION AFTHEAWAfrD
CATEGARY
{I NTE RN ATI ONAL/ NATIONAL/
fr EG fi N AL/ P R OV' NCI ALI1IWDt sTRt cr / s c H oo L/ u N lr )
AWARDED BY DATE AWABDED
DIGITALISCANNED COPIES REQUIRED:
Scanned Certificates and other pieces ofevidence ofawards or recognition reiateci totea{hingfromreputabi e organizati0ns.
9.3. Certilied List of Civilian/Cammunity Awards receivedSubmit a maximum of ten (10) best civiiian or community awards received in the entire career. lndicate the
citation ofthe award, year received, and authorized body. List of award should be arranged aceording to the
award's importance (highest to lowest).
CAMMUNITY STRVICE AWARDS
TIT!-E AFTHE AWARD
CATE6QRY
//iJIERNA IIONA L/ N AN A N AL/x E 6 fi NAL/ P R AV N C t A LIC tTv/
MUN./BR6v)
AWA*DED 8Y DATE AWAKDED
DI6ITAL/SCANNED COPIES REQUIRED:
Scanned Certificates and other evidences of awards received for cornmtlnity service or for being an
r:utstanding rrember in the community (e.g. Outstanding MotherlFaiher Award, Outstanding Citizen
Page 2 of 5
1 page
2 pages
2 pages
FOR TEACHER NOM|NEES ONLY {8.4 - 8.7}
SOIDIfRS AND PAUCE OFFICERS, please proceed fo PAGf 5.
8.4. DAILYIWEEKLY TEACH/,NG SCHEDaJLE{Io be certified by the registrar / schaal officiols concerned)
Submit a certified true copy of the daily / weekly teaching schedule / program for the current school year
including the acjministrative duties and other assignments being handled by the nominee, if any. lndicate also
the level of each subject being taught {e.g- Grade 6, 4th year, undergraduate, or graduate} and the totai no- of
hr.rurs or units per subject. lndicate your school's definition of full load.
For Elementary and Secondary: The Teacher's Program should indicate the total number af HOURS per week.
For Higher Education: Please submit the teaching schedules for the current school Year, which should indicate
the total number cf UNITSICONTACT HOURS per term. For those who are not abie to teash in the lst term ofthe current school year, piease submit also the teaching schedule during summer of the previous school year"
Submit also a certiflcation summarizing the total no. of unit loadsfcontact hours for the whsle academic year.
This inciudes semestral, trimestral and summer of the previous school year.
8.5, INSTRUCflONAL CCIMPEIENCE AND TEACHING TFFSCT'VENESS
List down a maximum of ten i10) major !-Etgg!g!gj$.g:gdg!: produced by the nominee during his/her entire
career as a teacher. Use the format below i8.5.1.1 and 8.5.1.2) in listing down the published or unpublishedinstructicral materia ls.
8.5.1 Certilied List of lnstru.tionsl Materidls pradu€ed and used lar the impravement af tecchinglnstructional materials are outputs related to profession, contributing to the objective of improving classroom
instruction. lnstructional materials SHOULD BE RELEVANT to the Level in which the nominee is nominated for
and to the subject area he/she teaches. Da NAT include periadic tests, daily lesson p/ons used only in the
nominees' classraom, news itemsf articles published in the school paper, and brachures.
8.5.1., Published books, big baaks, warkboaks, madules and iaurnal orticles
7yPE TITLE YEAR
DESCR'PI'O'V
{OBJECTIVEAND
PURPOsE)
AUTHOR.S 15li\i6rr OR CO-AUTHORSHTP) /LEVEL OF ADOPTrcN {SCHAAL-W|D|,
c oL LE G€l U t$ lV rRS lW-W tD E, Dt STRICT/
DtvstaN/ RrGtoN-wlDE, NAilONW|DE, tr[.]PUSLISHER
DIGITAL/SCANNED COPIES REQUIRED:
Proof of PUBLISHED books, big books workbooks, modules and professional articles:r' Title pageI Copyright page {with publisher & publishing house
workbooks snd module8.5.1.2 books, 's.
TYPE TITLE vfefrDESCRIPTION
{oBJEOwEAND PURPASE}
AUTHAR/S Fs'NGTE OR CA-AUTHARSHIP) / LEVEL OF
ADAPTON {SCHAOL-W| DE, COLLEGE/ UvlvrBslry-wt DE, D|STNCTI DtVtStONl RrGioAt-yvJDq,
NATIONWIDE, ETC.)
8.6. IAr^rOyAT|VE TEAClllNo A?PROACHT' pRACITCTS, A'VD SrRAru',GrES
Using the format below, list down a maximum of ten {10) major gisinal/inno-vjttive-lwblngpqsroaches/*Iatesigs/pr actices produced by the nominee during hislher entire career as a teacher.
€ertified summary of tap ten ftA] innavstive teaching dpprodches/practices/ strdtegies
TITLEBRIEF
DESCS'PT'ON
,s tT oRtctNAL/ Mo.DiFIED O& ADA?TE0 APPROACH
OR STRATEGY?
DIGITAL/SCANNED COPIES REQUIRED:
EI n.tion Photos or Videos of originaU innovative teaching approaches/ practices/ strategies
EI for. Hieher Education Nominees: Syllabus reflecting Outcomes-Based Education
DtGITAI/SCAN NED C0Plt5 REQUIRED:
Proof of UNPUBLISHTD bcoks, big books, workbooks, modules and professional ariicles:I Title pagesr' Certification of exlent of use / level of adopticn
Page 3 af 5
8.7 AilGWAL BTSEAfrCHAII'D CREATNE AUPUTSList down a maximum of ten {10) orisinal research and ien {1jElqeativqoUlBullS produceC by the nominee
during hislher entire career as a teacher.
Research is defined as an output specifically produced for academic or instruct!ona! purposes" Creative
works are published/performed poetry, short stories, feature articles, nrusical composition, noveis,
essavs, presented/pr"ocluced plays, exhibits, concerts and stl^rer creative production, as rseli as innovative
teathtng devices prodticed,
8"7"1. €ertified list of reseorches €ompteled by the nomineeIlse the farmot below to lrsr dorvn the resetrrches completed. Do NAT inciude thesis/dissertution arstudents' investigotor'/ proiects where the nominee is the caach or *dviser,
DrGITAL/SCANNED CAPIES REQUIRE0:
M Proofof Research*s CompletedAbstra{ts for each completed research {to include ratianale, objectives, metltods ar pracedures, maior
ftndings, recommendction and impa* af tlle study)
8.7.2 Certified list of creotive outputsgplglgg!by the nomineellse the formct below {8.7.2.1 ^ ts.7.2,3) to list dovtn the rreative autputs that yau h*ve published,
prese rtted, o r prrsdu ced"
$"7.2.7 ?ublished/*tq-nte4-18lpdqsgd.ploys, novels, exhibits, concerts snd nther praductian
DIGITALISCANN ED COPIES REQUIRED:
EI Proof of Creative Works {Performing Arts}./ 3 Photos of actual event {with captions)./ Certificates (if
fi.7,2.2 Pgfulj;fuf,or presenteslpoetry, short stories, musical ramposition,feature artlcles, oressoys (written)
WPE TITLEINDICATE IF IT
'S AM ORIEINAL/ADAPTfi/
RTY'SED VERSIAN OF THE ORIoINAL
DAff PEfSfIfIfD OfiP{lgtis}rE
DIGITAL/SCANNED COPIES REQUIRED:
EI Proof of Creative Works {Written},/ 3 Fhr:tos of actual event {with captions}'/' Scanned copy ofthe actual publishedlpresented written rvork./ Certificates {if any)
8.V.2.3 Ariginol teoching devircsList down original teaching devices madelirsed during entire career as a teacher.Aa NAT inclu<1e existing teaching deyices sucA as movie/TV bax, f iash cards, charts, pawerpaint materials"
These are not considered as innavative r:nles1 the norninee has made improvements o* the design.
IYPE TITLE NATUBE/ DESCRIPT'ON HAW & WHEN IS
'T USED
DIGITAL/SCANNED COPIES EEQUIRED:
EI Phntos or Videos of innovative/ improvisedl indigenous teaching devices with caption.Provide a brief description of each. $ not original, describe adaptattons/madifications/ enrichments made.
wpE T'TLE
DATE/S
srIRrcD&{OIVIPLETED
DATE
PUBL'SHED
$FAPPLICAELE)
PUSLISHEfi
RALE AF NOMINEE
{SALE frESEARCHER, TEAMMEMBER/TEAM LEADER}
or creative wark
TYPE TITLE
,S 'IORIC|/NAL/ADAPTE
DIREV[SED?
DATfPRESENTEa OB
FRODUCED
ROLE OF THE NOM$dEE {8.C. D&EC'{AR,
PRODUCEB SCRIPTWRITER, CURATOR, ETC.}
I pages
Fage 4 of S
V. MILESTONE ACCOMPLISHMENTS {Please see otttched Guidelines in Writing the MilestoneAeomolishments End Templqte an Milestane Accomplishrnents]
40 pages
V1. CTEARANCES
TEACHERS SOLDIERS
a) Certificate of 6ood MoralCha racter
blNational Bureau oflnvestigation Clearance
a) all pertinent AFP bodies {i.e. Office ofthe Deputy Chief of Staff forlntelligence, 12, JAGS, lnspector 6eneral,Provost Marshall, Office of Ethical
Standards and Public Accountability,DLO)
b) Commission on Human Rights
c) office of the Ombudsman
a) Commissiein on Human
Rights
b) Office of the $mhudsmanc) National Bureau of
lnvestigation Clearance
2 pages
Vll. _CASE DETAILS {if applicable)Fcr ncminees who have been CHARGED or CONVICTED with criminai, civil, or administrative off*nse, please submit a
shert report ivhlch includes the following: {Please submit a report even if the *se has been dismissed or amicably
sett!ed)a. Case number and nature of charge {libel, estafa, physicai abuse, etc,}b. Date the charge iruas fi{edc. Vlhere the charge was filed (City / Municipai / Regianal Trial Courtid. Circumstances surrounding the corrplainte. Status/Final Resoiution {penciing / on-going, amicably settled, dismissed, etc"}
NATE: For nominees vtith pending case, submit a Certification/Declaroticn from Regianal/Nationaf Assistonce
Board !fr4'ILAB); Far naminees with pending case classified as hdrossrnent suit,/s, submit a certificaticsn lrom the
Natianal Support Unit Legol Assistonce Boord I,NSUI,A8J"
2 p*ges
VII. CERTIFIED TRUE COPY OF PERSONAL DATA SHEET 4 pages
Page 5 r:f 5
POLICE OFFICERS
itrnciosure to No. 4 to Deptrd Merreor:andum No. 003, s. 2018)5i] r'::roiant Foundaii**
(-r' i. i \\l)l\,,:lil i{)lr..id}i: ii.il !ir*t rj,ri4t\
DOCUMENT 2
GUIDELINES IN WRITINGTHE MILESTGNE ACCOMPLISHMENTS
Please read the following guidelines carefully before accomplishing the attached forrnl-- Af'rswer ea.t' ii.T as :':ncrseiy as you can. You may use up to 4 pages {long bond paper {8"xi3") rriith 1" margin on ali ride:, Ariai.:^.. si;e ll .:. ::-- * le)il.r? acccn:piishmenl,2. Descilbe ',,--rr ten {10} milestone accomplishmenli in the c**rse of your career as a teacher, saldier', or police officer in earh olilese two 'r; ,.r caregcries: a. Five {5} kntributions to Service; and b. Five {5} Contributions to Community.3. Ycuc;r, l:\.ir;uiafiilestoneaccomplishmentONCE*eitherascontributiontoserviceorccntrii:utiontoccrmmunity..: ii.3s=re':'io:hefollowingDefinitionofTerrnstoguideyoururderstandingcftlreinii:rrnatrexbeingrequestedtraryr
TERM DESTNTTTON / GU|DE QUESTTON$
M il estone Accomplishments
A milestone accomplishment is what defines you and your car€er as a teacher, a scldier, ar a
police ofiicer'. it may have any or ail of the foliowing characteristics:a) An innovation or discoverythat addresses a felt need and heips overcome a major abstacle
or problenr in your school, urorkpiace, or communityb) Creates significant pssitive impact on the target beneficiaries, be it in yaur school,
workplace, o!" rommunityc) Sustrinable, i.e. the intended innovations, changes, and reforms continue to be carried orrt,
or goods and services continue to be provided to the iarget beneficiaries over a pericd oftime
Contributions to Service
Teaehersi Refers to the teacher's contribution in the teaching profession that benefits thecommunity of learners within the school/academic instituiian she./he belongs to. As silch, thecontri!:utlcn's beneficiaries, scope, and impect only affects the school/academir institutianshe/he is in.
Scme examp!es:1) Modules, teaching arrd learning guides, academic curriei";la, NAT reviewers, and other
related learning materials2) Research, i.e. operations andfor acadenric researeh/action research that impraved
learning processes within the school
3) A drsco,Jery or innovation, such as teaching devices sr epparatus4) Technolo6y-baseci Iearning tools {e.g. iearning games, gamification)
Soldiers and Police Officers: Refers to accompiishments that rontribute to realiring the mission
anC.;ision of secui'ing the country's sr:vereignty, promction of peace, and ensuring order in thecomm u n ity.
Some exanrDies:
1) Neutralization of enemies of the state or most watrted criminals2) Feaceful resolution of armed conflicts3) lnnovations, pclicies, or manuals that benefit :pecific units of the PNP or AFF in general
4l Formulation of policies and strategies that controls the prevention of corrupiion in theprocurement of assets such as firearms, vehicles, planes, ships, etc.
5) lntroduction of a standardized training for Commissioned and Non-Commissioned Officers
that was approved by the PNPiAFP leadership *nd eventualiy adopted by al! units ofPNPIAFP,
Contributions to Community
Teache{si Refers to the tearher's contrihution t* ihe bigger academic communit-y ouiside of
their own school, i.e. within their distrirt, divisian, region, or the entire national edurati*nalsystem. This may also refer to contributions thai benefit the greater commufiity ctltside the
educational systern.
Some examples:1) Preparation of NAT Revjewer in Science that is being used by other schools in a DepEd
Division aside from the teacher's own schecl2) Research (natir:nally or internationally cited which impacted the area of reseat'ch,
iearning discipline, cr benefited a ccmmunity ol'contrnunities outside the educatir-:naltrictamiJyJrL"r,
3l Publicaiions, such as books, manuels, poiicy papers, ett.4) Technology-based teaching-learning toois adopted by other" teachers outside ilf the
teacher's own school
5l Outreach to far-flung areas or nearby barangays that aims to educate a targetpopulation, train individuals, or provide needed gocds and services
Page 1 of 2
Contributicns to Community
Soldiers anli Pqlile ,Qffiqlr! Refers to an accomplishments that serve the AFP or the PNP
community in general anci external communiiy which may include individual *nd organizational
partners and stakeholders, and the larger Philippine society.
Examples of such accomplishrrents are:
1) Advanced cornmunity policing tr"aining and seminars adopted by b,arangay peace
keeping afficials?) Creation of portable airBort runway lighting system from scrap metals that was used in
areas during calamities to for relief and rescue missions and also in air farce bases
natiorrwide.3) Headed a multi-sectoral committee that Frotected coastiines which helped sa{egrrard
the incorne saur"ce of fisher foik4) lnstitutionalizaticn of Defense/police Acquisition Systenr and creation of Defense/Police
Acquisition office5) Conceptualization of a multi-sectoral engagement far Pabahay and liveiihood programs
f ar bafik-loab members of the New People's Arm.J
Accomplishrnent State in cne phrase what your accomplishment is about.
1. Yoirr Specific Role ln lt Briefly describe your role in the accomplishmeni/pr"oject. Wer€ you the team leader or teammernber? How was ycur role critical to the success of the accomplishrnentlproject?
2. Brief Description ofAccomplishment
2.1. Rationale
2.2. Objertives
2.3. Dates started andcompleted
2.4. Coverage
?q, Beneficia ries
Key PartnerlmplementingOrganizations/lndividuals
2.7. Source of Funding
?.8. innovation
2.9. Irnpact
2.6.
Describe the nature of your accomplishment by answering the following qLlestions. Be concise.
What need er problem did your accomplishment respond to? What made ysu decide to getinvolved in it?
What did your accomplishment aim to achieve?
When did the accomplishment take place? {start and end dates}
Where did the accomplishment take place? {e.g. city, province} What was the scope of theaccomplishment? {e.9. unitlschool/divisionlregional/national/internaiional}
Sriefiy descrioe ire :eneficiaries of your acco:'nplishment. H w many were they? \{lhat sectors
did ihey conre fronr? (e.9. teachers, studenis, indigenous pecpies, urban pocr, etc.)
Th!s incluces internal stakeholders from the school or concerned AFP//PNP unit where theteacher, scioi*r or police officer is assigned who helped work on the accompiishment (e.g. fello,*teachers. soldier:, police officers). lt also inclucies external stakeholders from outside the school
u- AFPIiFNP unit who helped realize the accomplishment {e.g. cioncr" agency/individual, LGU,
!ocal NGo partneri, Externa! stakeholders are ;lso those rvho bentflted fram thealco.n rlrsrrrent ind irectly).
List down at least five {5) key persons who were involved in the inrplementation of your
accomplishment. lnciude their posiiions, organizations and addresses, landline/mobilenumbers, e-mail addresses, and a brief description r:f their contributions ta the milesloneaccon: plishments.
What were the names of the cionor agency or individuals who prervided financial andlor in-kindassistance to help you realize your accornplishmeni? lnclude their contact details imailingaddress, landilne/ mobile numl:ers, ernail addressj.
Did you introduce innovations as a course of action or as an integral part of iheaccomplishment? Please describe the innovation and the results orgains obtainsd.
What were the immediate results of your accomplishment/projecr? Please describe theoutcomes/impact of the intervention on the beneficiary community.
Page 2 of 2
to Dei,.Eri i''ier:roi-andum No" ilt].3, s. 20181FORM 2
TEMPTATE CN MTLESTONE ACCOMPLISHMEiITS
Name
(urr**t Fasition
Name of School/tlnil of Assignment
Address of School/Office
No. of Years in Service {For teachers,Total Years of Teaching Experience)
Highest Educatironal Attainment
A. COT]TRiBUTIONS TS SERVICT
Accoraplishment # _(state in one phrose)
1. Your Spetific Role in lt
2. Brief Description of Accemplishrnent
2.1. Rationale
2.2. Obiectives
2.3. Dates started and completed
2.4. Coverage2.5. Beneficiaries
2.6. Key Partner lmplementingergan i:ationsl lndividuals
Use the foll*trring forrnatl
Name PrsitionSnganirationand Address
Mablle,/Telephone
N*mber
addre*sBrief Deseription cf
esntributio*
2.7. Souree of Funding
2.8. lnnovation
7.9. lmpact
3, EvidenceslReports/PicturesfNews clippingslCase repori of acf,omplishrnents submitt€d
3, CONTRiBUTTONS TO COMMUNITYAccomplishment # _{state in one phrase)
1- Yaur Specific Role in It
?. Brief Description of Accornpiishrnent2.1-" Hationaie
S.I.0bjectives
2,3, Dates started and c*mpl*ted
2"4" Cf,verage
2.5, Eeneficiaries1,6 *{ey Partner lraplementingorganizations/ {ndlviduals
Use the following format:
trlarne FositianGrganizationand Address
M+bilelTelephone
Nur*her
address
Brief iles*iption efContribution
7.7. Source of FundinE
2.8" lnnovatiEn2.S. impact
3. EvidenceslReportslPicture*lltlews elippingslCase reports of aceonrplishments suhmitted
Page L of 1"
