RA 9299 Republic of the Philippines June 25, 2004

NEGROS ORIENTAL STATE UNIVERSITY

College of Teacher Education

Sibulan Central Elementary School

Yapsutco St, Sibulan
Negros Oriental

March 21, 2023

Dear Participant:
This questionnaire is designed to study the Difficulties Encountered in Teaching
English to Multiple Disability with Visually Impaired Learners, Non Graded: Basis for
Developing a Training Design. The information you provide will help us understand the
aforementioned study. With your relevant knowledge and expertise, we request you to respond to
the questions frankly and honestly.
Rest assured that your response will be kept confidential. Only the members of the
research team, including the research advisers and the statistician, will have access to the
information you provide. In order to ensure the utmost privacy, we have provided an
identification number for each participant. The number will be used by us only for follow-up
procedures. The numbers, names, or completed questionnaire will not be made available to
anyone other than the research team. A summary of the results will be mailed to you after the
data are analyzed.
Thank you very much for your time and cooperation. We greatly appreciate you helping
us make this research endeavor a reality.

Respectfully Yours,

MERABELIS, MARICON C. SAEL, JAZZEN F.

Researcher Researcher

Noted by:
CRAIG N. REFUGIO, Ph.D. JURAM TABLATE, MAEd
Research Professor Research Adviser

(Adapted from the work of Dr. Craig N. Refugio)

 RA 9299 Republic of the Philippines June 25, 2004
NEGROS ORIENTAL STATE UNIVERSITY
College of Teacher Education

“Difficulties Encountered in Teaching English to Multiple Disability with Visually

Impaired Learners, Non Graded: Basis for Developing a Training Design”

INTRODUCTION
The College of Teacher Education of Negros Oriental State University, Main
Campus 1, the Bachelor of Special Education Program, and the Researchers support the
practice of protection for human subjects participating in any form of research. The following
information is provided for you to decide whether they wish to participate in the present study.
You may refuse to sign this form and not participate in this study. You should be aware that even
if you agree to participate, you are free to withdraw at any time. If you withdraw from this study,
it will not affect your relationship with the aforementioned agencies.
PURPOSE OF THE STUDY
To collect data about the difficulties encounter in teaching English level 1 to visually
impaired learners: basis for developing a training design.
PROCEDURES
You will be asked to answer the items attached questionnaire and during this process,
audio recordings will be taken as an additional tool for the collection of data. You have the
option to refuse or stop the taping at any time. Audio recordings will be transcribes by the
research committee headed by Dr. Craig N. Refugio, rest assured that the audio recording will be
stored with utmost security and if necessary the recordings will be erased/destroyed.
BENEFITS
You will be the direct beneficiaries of the training design that can be developed in this
assessment research.
PAYMENT TO PARTICIPANTS
THE RESEARCH PARTICIPANT WILL NOT RECEIVED ANY PAYMENT IN
PARTICIPATING IN THIS STUDY.
PARTICIPANT CONFIDENTIALITY
Your name will not be associated in any publication or presentation with the information
collected with the research findings in this study. Your identification will not be shared unless
(a) it is required by law or university policy, or (b) have a written permission.
Permission granted on this date to use and disclosure the participant’s information
remains in effect indefinitely. By signing this form the participant’s give permission for the use
and disclosure of the information for purposes of this study at any time in the future.
 RA 9299 Republic of the Philippines June 25, 2004
NEGROS ORIENTAL STATE UNIVERSITY
College of Teacher Education

REFUSAL TO SIGN CONSENT AND AUTORIZATION

The participants are not allowed to sign this Consent and can refuse to do so without
affecting their right to any services they are receiving or may receive from the training design
that can be developed in this study. However, if you refuse to sign, you cannot participate in this
study.
CANCELLING THIS CONSENT AND AUTHORIZATION
The participant may withdraw the consent to participate in this study at any time. You
have the right to cancel your permission to use and disclosure further information collected about
you in writing, at any time, by sending your written request to:
EMAIL ADDRESS: [email protected] OR [email protected]
If you cancel permission to use your information, the researcher will stop collecting
additional information about you. However, the researcher may use and disclosure information
that was gathered before received your information, as you described above.
QEUSTIONS ABOUT PARTICIPATION should be directed to:
MERABELIS, MARICON C.
SAEL, JAZZEN F.
Researcher, Bachelor of Special Needs Education Major in General Curriculum
Negros Oriental State University – Main Campus 1
Dumaguete City
---------------------------------------------------------------------------------------------------------------------
PARTICIPATION CERTIFICATION
If you agree to participate in this study, please sign where indicated, then tear off this
section and return it to the data collector(s). Keep the consent information for your records.
I have read this Consent and Authorization form, I have had the opportunity to ask, and I
have received answer to, any questions I had regarding the study and the use and disclosure of
information about me for the study.
I have agree to take part in this study as a research participant. By my signature, I affirm
that I am a Special Needs Education Teacher from the Province of Negros Oriental and that I
have receive a copy of this Consent.

Print Participant’s Name Date

Participant’s Signature
 RA 9299 Republic of the Philippines June 25, 2004
NEGROS ORIENTAL STATE UNIVERSITY
College of Teacher Education

West City Exceptional Learning Center

Jose Pro. Teves St, Dumaguete City
Negros Oriental

March 21, 2023

 RA 9299 Republic of the Philippines June 25, 2004
NEGROS ORIENTAL STATE UNIVERSITY
College of Teacher Education

Dear Participant:
This questionnaire is designed to study the Difficulties Encountered in Teaching
English to Multiple Disability with Visually Impaired Learners, Non Graded: Basis for
Developing a Training Design. The information you provide will help us understand the
aforementioned study. With your relevant knowledge and expertise, we request you to respond to
the questions frankly and honestly.
Rest assured that your response will be kept confidential. Only the members of the
research team, including the research advisers and the statistician, will have access to the
information you provide. In order to ensure the utmost privacy, we have provided an
identification number for each participant. The number will be used by us only for follow-up
procedures. The numbers, names, or completed questionnaire will not be made available to
anyone other than the research team. A summary of the results will be mailed to you after the
data are analyzed.
Thank you very much for your time and cooperation. We greatly appreciate you helping
us make this research endeavor a reality.

Respectfully Yours,

MERABELIS, MARICON C. SAEL, JAZZEN F.

Researcher Researcher

Noted by:
CRAIG N. REFUGIO, Ph.D. JURAM TABLATE, MAEd
Research Professor Research Adviser

(Adapted from the work of Dr. Craig N. Refugio)

“Difficulties Encountered in Teaching English to Multiple Disability with Visually

Impaired Learners, Non Graded: Basis for Developing a Training Design”

INTRODUCTION
The College of Teacher Education of Negros Oriental State University, Main
Campus 1, the Bachelor of Special Education Program, and the Researchers support the
practice of protection for human subjects participating in any form of research. The following
 RA 9299 Republic of the Philippines June 25, 2004
NEGROS ORIENTAL STATE UNIVERSITY
College of Teacher Education

information is provided for you to decide whether they wish to participate in the present study.
You may refuse to sign this form and not participate in this study. You should be aware that even
if you agree to participate, you are free to withdraw at any time. If you withdraw from this study,
it will not affect your relationship with the aforementioned agencies.
PURPOSE OF THE STUDY
To collect data about the difficulties encounter in teaching English level 1 to visually
impaired learners: basis for developing a training design.
PROCEDURES
You will be asked to answer the items attached questionnaire and during this process,
audio recordings will be taken as an additional tool for the collection of data. You have the
option to refuse or stop the taping at any time. Audio recordings will be transcribes by the
research committee headed by Dr. Craig N. Refugio, rest assured that the audio recording will be
stored with utmost security and if necessary the recordings will be erased/destroyed.
BENEFITS
You will be the direct beneficiaries of the training design that can be developed in this
assessment research.
PAYMENT TO PARTICIPANTS
THE RESEARCH PARTICIPANT WILL NOT RECEIVED ANY PAYMENT IN
PARTICIPATING IN THIS STUDY.
PARTICIPANT CONFIDENTIALITY
Your name will not be associated in any publication or presentation with the information
collected with the research findings in this study. Your identification will not be shared unless
(a) it is required by law or university policy, or (b) have a written permission.
Permission granted on this date to use and disclosure the participant’s information
remains in effect indefinitely. By signing this form the participant’s give permission for the use
and disclosure of the information for purposes of this study at any time in the future.

REFUSAL TO SIGN CONSENT AND AUTORIZATION

The participants are not allowed to sign this Consent and can refuse to do so without
affecting their right to any services they are receiving or may receive from the training design
that can be developed in this study. However, if you refuse to sign, you cannot participate in this
study.
CANCELLING THIS CONSENT AND AUTHORIZATION
 RA 9299 Republic of the Philippines June 25, 2004
NEGROS ORIENTAL STATE UNIVERSITY
College of Teacher Education

The participant may withdraw the consent to participate in this study at any time. You
have the right to cancel your permission to use and disclosure further information collected about
you in writing, at any time, by sending your written request to:
EMAIL ADDRESS: [email protected] OR [email protected]
If you cancel permission to use your information, the researcher will stop collecting
additional information about you. However, the researcher may use and disclosure information
that was gathered before received your information, as you described above.
QEUSTIONS ABOUT PARTICIPATION should be directed to:
MERABELIS, MARICON C.
SAEL, JAZZEN F.
Researcher, Bachelor of Special Needs Education Major in General Curriculum
Negros Oriental State University – Main Campus 1
Dumaguete City
---------------------------------------------------------------------------------------------------------------------
PARTICIPATION CERTIFICATION
If you agree to participate in this study, please sign where indicated, then tear off this
section and return it to the data collector(s). Keep the consent information for your records.
I have read this Consent and Authorization form, I have had the opportunity to ask, and I
have received answer to, any questions I had regarding the study and the use and disclosure of
information about me for the study.
I have agree to take part in this study as a research participant. By my signature, I affirm
that I am a Special Needs Education Teacher from the Province of Negros Oriental and that I
have receive a copy of this Consent.

Participant’s Name Date

Participant’s Signature