Republic of the Philippines
Department of Education
DepEd Complex, Meralco Avenue
Pasig City 1600
Effectivity Date:
Version No.
Revision No.:
Page No.:
Professional Development Program/Course Recognition Application Form
Reference No.:
INSTRUCTIONS: Input the necessary details. Indicate N/A if not applicable. DO NOT ABBREVIATE.
LEARNING SERVICE PROVIDER PROFILE
Learning Service Provider
Type the complete name.
Complete Office Address
Type the complete office address.
Contact Person
Telephone No.
Type the complete name.
Type the office telephone no.
NEAP Authorization Number
Mobile No.
Email Address
Type the mobile no.
Type Email address.
For Authorized Learning Service Provider only.
Address: 2/F Mabini Building, DepEd Complex, Meralco Avenue, Pasig City 1600
Telephone No.: (02) 8638-8638 / (02) 8633-7207 / (02) 8635-4796
Email Address: neap.od@deped.gov.ph / askneap@deped.gov.ph
September 20, 2021
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CO-NEAP-F018
Republic of the Philippines
Department of Education
DepEd Complex, Meralco Avenue
Pasig City 1600
Professional Development Program/Course Recognition Application Form
Effectivity Date:
Version No.
Revision No.:
Page No.:
Reference No.:
September 20, 2021
1
00
2 of 6
CO-NEAP-F017
PROGRAM PROFILE
You will need to complete the following components to describe the program you would like to be recognized.
1Title
2Rationale
Type the Program Title here.
300-350 minimum words
(Outline the reasons for offering this program. You should consider the need this program addresses for teachers
and include an overview of how relevant and reliable research relates to the content and/or delivery of the
program. Include citations in your overview. Also, provide references to the sources outlined.)
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.)
3Program
Description
Terminal Objective is defined as what the participants will achieve upon successful completion of a program or
course.
STEM STATEMENT/S:
By the end of this Program, participants will be able to:
Enabling Objectives are the specific objectives that support the Terminal Objective/s.
4Professional
Development
Priorities
(State the DepEd Professional Development Priorities this program covered or DM 50 s. 2020 and/or other
emerging needs of the Department.)
Address: 2/F Mabini Building, DepEd Complex, Meralco Avenue, Pasig City 1600
Telephone No.: (02) 8638-8638 / (02) 8633-7207 / (02) 8635-4796
Email Address: neap.od@deped.gov.ph / askneap@deped.gov.ph
Republic of the Philippines
Department of Education
DepEd Complex, Meralco Avenue
Pasig City 1600
Effectivity Date:
Version No.
Revision No.:
Page No.:
Professional Development Program/Course Recognition Application Form
5Target
7Delivery
(Please specify your participants based on their career stage, subject
area, grade level, etc.)
Participant
Platform
Reference No.:
Identify delivery platform here.
8Indicative
6PRC
Program
Accreditation
No.
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CO-NEAP-F017
(For Non-DepEd
LSPs)
Date of Implementation 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.
9Course
10Title
1
Type here.
2
Type here.
3
Type here.
4
Type here.
5
Type here.
11Professional
Standards Covered
(PPST, PPSSH, PPSS with
strand/s, indicator/s)
(PPST, PPSSH, PPSS with
strand/s, indicator/s)
(PPST, PPSSH, PPSS with
strand/s, indicator/s)
(PPST, PPSSH, PPSS with
strand/s, indicator/s)
(PPST, PPSSH, PPSS with
strand/s, indicator/s)
specific domain/s and
specific domain/s and
specific domain/s and
specific domain/s and
specific domain/s and
12Schedule
From Start
End Date
From Start
End Date
From Start
End Date
From Start
End Date
From Start
End Date
13Modality
Date to
Choose an item.
Date to
Choose an item.
Date to
Choose an item.
Date to
Choose an item.
Date to
Choose an item.
Add more row to add courses.
Address: 2/F Mabini Building, DepEd Complex, Meralco Avenue, Pasig City 1600
Telephone No.: (02) 8638-8638 / (02) 8633-7207 / (02) 8635-4796
Email Address: neap.od@deped.gov.ph / askneap@deped.gov.ph
Republic of the Philippines
Department of Education
DepEd Complex, Meralco Avenue
Pasig City 1600
Effectivity Date:
Version No.
Revision No.:
Page No.:
Professional Development Program/Course Recognition Application Form
Reference No.:
September 20, 2021
1
00
4 of 6
CO-NEAP-F017
COURSE DESIGN
Provide a detailed description of each of the course by breaking it into discrete sessions. You may create a copy of this page if you have two or
more courses.
14Course
15Course
Title
Description
16Duration
17Topic
18Session
19Methodology
Objectives
2 Type here. Type here.
Type here.
Explain, in detail, the professional
development activities including
the learning resources that
teachers/school leaders will
engage in, clearly describing how
the presenter will facilitate each
session and how the participants
will engage with the content and
meet the domain/s, strand/s and
indicator/s in the selected
Professional Standards. (100-150
words)
Type here.
3 Type here. Type here.
Type here.
4 Type here. Type here.
5 Type here. Type here.
State its
duration,
1
e.g. 90
minutes
Describe its
topic (focus,
content and key
learning points
or what
teachers will be
learning about).
(May be a listing
of main topics
or key
messages)
Describe its
session
objectives. (3050 words)
20Assessment
Strategies
Explain how
the learning
outcomes will
be assessed; if
possible
attach an
assessment
tool. (50-75
words)
22Resource
21Outputs
Person/ Learning
Facilitator
Identify the
Resource Person/
Learning
Describe what
Facilitator
teachers/school
responsible for
leaders’ outputs
this session. Use
to achieve
attached CV
learning
Template as
outcomes. (50reference.
75 words)
Type here.
Type here.
Type here.
Type here.
Type here.
Type here.
Type here.
Type here.
Type here.
Type here.
Type here.
Type here.
Type here.
Type here.
Type here.
Type here.
Type here.
Address: 2/F Mabini Building, DepEd Complex, Meralco Avenue, Pasig City 1600
Telephone No.: (02) 8638-8638 / (02) 8633-7207 / (02) 8635-4796
Email Address: neap.od@deped.gov.ph / askneap@deped.gov.ph
Republic of the Philippines
Department of Education
DepEd Complex, Meralco Avenue
Pasig City 1600
Effectivity Date:
Version No.
Revision No.:
Page No.:
Professional Development Program/Course Recognition Application Form
September 20, 2021
1
00
5 of 6
Reference No.:
CO-NEAP-F017
Add more row to add sessions.
PROGRAM/COURSE IMPLEMENTATION PLAN
23Funding
Source
How the program will be
funded?
24Budget
Requirements
Provide details on how the funds will be allocated. If registration, how
much will be collected in each course?
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.
Level of M and E
Indicators
Methods and
Tools
Data Sources
Schedule of M
and E
Person/s Responsible
Support Needed
User of M and E
Data
25Results
What will be What
Who and/or
When will M
Who will be accountable
measured? methods/tools what documents and E activities for ensuring that M and
will be used to will provide data be undertaken? E activities are done?
collect data? or evidence on
the indicators?
What resources Who will use the
are needed to
data gathered?
implement M and
E activities?
26Behavior
Type here.
Type here.
Type here.
Type here.
Type here.
Type here.
Type here.
27Learning
Type here.
Type here.
Type here.
Type here.
Type here.
Type here.
Type here.
28Reaction
Type here.
Type here.
Type here.
Type here.
Type here.
Type here.
Type here.
Address: 2/F Mabini Building, DepEd Complex, Meralco Avenue, Pasig City 1600
Telephone No.: (02) 8638-8638 / (02) 8633-7207 / (02) 8635-4796
Email Address: neap.od@deped.gov.ph / askneap@deped.gov.ph
Republic of the Philippines
Department of Education
DepEd Complex, Meralco Avenue
Pasig City 1600
Professional Development Program/Course Recognition Application Form
Effectivity Date:
Version No.
Revision No.:
Page No.:
Reference No.:
September 20, 2021
1
00
6 of 6
CO-NEAP-F017
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.
Sign off by the Program/Course Manager or its equivalent
Program Manager
Type here
Signature
Date
Click here to enter a date.
This Form 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
Address: 2/F Mabini Building, DepEd Complex, Meralco Avenue, Pasig City 1600
Telephone No.: (02) 8638-8638 / (02) 8633-7207 / (02) 8635-4796
Email Address: neap.od@deped.gov.ph / askneap@deped.gov.ph