PRIORITY NO.

____
Del Pilar Academy
SENIOR HIGH SCHOOL
RESEARCH STUDIES

Form 004

PRELIMINARY RESEARCH PROPOSAL INFORMATION SHEET

(To be accomplished by RESEARCH WRITING STUDENTS)

Please use this form or electronic equivalent.

NAME OF RESEARCHER: ________________________________________________________________
GRADE: ____________________________________________________________________
ADDRESS: ______________________________________________________________________________
HOME/OFFICE PHONE: ____________________________ MOBILE PHONE:______________________
E-MAIL: ________________________________________________________________________________

RESEARCH TITLE: ______________________________________________________________________

________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
DURATION OF THE STUDY: _____________________________________________________________

BRIEF BACKGROUND / RATIONALE OF THE STUDY: ______________________________________

________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
RESEARCH OBJECTIVES/STATEMENT OF OBJECTIVES/PROBLEMS:
General:_________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
Specific:_________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________

RESEARCH DESIGN: Briefly discuss your methodology/methods/ techniques in gathering and analysis of data.
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
SIGNIFICANCE: Briefly discuss the importance of your study.
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________

WORKING BIBLIOGRAPHY: Write at least five (5) recent references.

________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________

COMMENTS OF EVALUATORS: the two others are from the F department faculty
Evaluator 1: Bb. MARY GRACE Y. BLANCO
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________

_______________________
Signature over printed name

Evaluator 2: _____________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________

_______________________
Signature over printed name
Evaluator 3: _____________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________

_______________________
Signature over printed name
 APPROVED
 CONDITIONALLY APPROVED (Condition/s:___________________________________________)
 DISAPPROVED (Reason/s: __________________________________________________________)

SIGNATURE OF THE RESEARCHER_______________________________ DATE:__________________

APPROVED by: _____________________________ ___________________________________
RESEARCH TEACHER CLASSROOM ADVISER
Date: _______________________ Date: ______________________________