Data Gathering Instrument For Trainee
Data Gathering Instrument For Trainee
Name:_________________________
Date:_______________________
Direction: Please answer the following instrument according to the characteristics described below.
Encircle the letter of your choice that best describes you as a learner. Blank spaces are provided for some
data that need your response.
A. Language, literacy and numeracy (LL&N)
1. Average Grade in ENGLISH
a.95 and above
b. 90 to 94
c. 85 to 89
d. 80 to 84
e. 75 to 79
c. 85 to 89
d. 80 to 84
e. 75 to 79
d. Others(pls. specify)__________
E. Age
a. Male
a. 15
b. Female
b.16
c. 17
F. Physical Ability
1. Disabilities(if any):
____________________________
d. 18
e. 19 and above
1 year ago
2 yrs. ago
3 yrs. ago
4 yrs. And
beyond
1 year ago
2 yrs. ago
3 yrs. ago
1 year ago
2 yrs. ago
3 yrs. ago
1 year ago
2 yrs. ago
3 yrs. ago
1 year ago
2 yrs. ago
3 yrs. ago
4 yrs. And
beyond
4 yrs. And
beyond
4 yrs. And
beyond
4 yrs. And
beyond
G. Training Levels Completed (if no training, pls write N/A on all blank spaces)
List down National Certificate acquired
1.
2.
3.
4.
5.
6.
7.
II
II
II
II
II
II
II
III
III
III
III
III
III
III
IV
IV
IV
IV
IV
IV
IV
B. Kinesthetic - described as
the students in the classroom,
who have problems sitting still
and who often bounce their
legs while tapping their
fingers on the desks. They are
often referred to as
hyperactive students with
concentration issues.
a. Financially challenged
b. Solo Parent
c. Working Student
I hereby certify that the data provided in this form is true and correct as to my knowledge