Basic Life Skills Lessons

Filling Out a Form

 Filling Out a Form
Learning Objective: New Vocabulary:
1) Understand common, universal Nombre ‐ First Name
information necessary to fill out a form Apellido ‐ Last Name
2) Effectively fill out a basic form ie: Dirección de la calle ‐ Street Address
money wiring form, store discount form, Ciudad ‐ City
basic health care form, driver’s license Estado ‐ State
application form, etc. Código Postal ‐ Zip Code
Fecha ‐ Date
Materials: Cantidad ‐ Amount
1) Blank form that is included with this lesson Número de Teléfono ‐ Phone Number
2) Other sample forms mentioned above Fecha de Nacimiento – Birth Date
when applicable
3) White board (or notebook)

LANGUAGE NOTE: The following lesson is intended to be taught entirely in Spanish for
beginning English Language Learners. If your student has a more advanced language level, this
same lesson can be taught using as much English as is appropriate. If your student is already
familiar with the vocabulary used to send a money order, you can choose a more complex form,
such as a dental or health form, and adapt the lesson accordingly.

LESSON NOTE: Use forms that are most applicable to meet the needs of the student.
Discover how they send money to family in native country and assist them with these forms if
helpful. Discuss how students may choose to deal with certain questions on a form such as
social security number and number of dependents. Also discuss how the date is written in a
different format in the United States.

Time Procedure

5 Minutes I. Give Pre-Assessment

5 Minutes II. Warm-up

Discuss whether your students have any previous experience filling out
common forms in either English or Spanish. For example, have they filled
out money orders or doctor’s office forms? Do they have discount cards for
Rite Aid or local grocery stores?

10 Minutes III. Fill Out Form

a) Fill out the attached form with student. Begin with a form in Spanish
and then fill out a form in English. This process will allow them to
become familiar with the form if they aren’t already and gather the
information they need to fill it out.
b) Using the form as a reference, make a list together of new vocabulary
on the white board (see vocabulary box above).
10 Minutes IV. Practice Vocabulary
Using the text on the white board as a visual aid, have the students repeat
the English word after you say the Spanish word followed by the English
word. Practice a few times until you can point to the words on the board
and students can read them.

5-10 Minutes V. Form-Filling “Pictionary”

Once students are familiar with the words and can comfortably pronounce
them, erase them from the board. Test and reinforce students’ knowledge
of the words by playing “Pictionary.” For example, the teacher writes “802-
279-3898” on the board and students say “phone number.” Teacher writes
“López” and students say “Last name.”

5-10 Minutes VI. Practice Forms

a) Give students sample English-only forms to fill out using sample
information (see sample information and form provided with this
lesson). Use “scrambled” and/or regular form depending on level of
difficulty your student needs.
b) Practice and reinforce any vocabulary that students struggled with
when filling out the form.

10-15 Minutes VII. Give Post-Assessment

VIII. Conduct Skills Assessment Below

Give students a second copy of the English-only form and ask them to fill it
out without assistance using their own information. Work together to
complete any parts that the student may have left blank in order to review
and reinforce any vocabulary they may not have mastered.

15 Minutes Enhancement Activities

Take a photo of the filled-out form with student’s cell phone camera for
their future use when filling out forms.

Skills Rubric
1 2 3 4

Student Student Student is Student is

is unable completes less able to able to
to do than 7 sections complete 7-8 complete the
task. of the form or sections of the entire form
completes it form without without
with assistance. assistance.
assistance.
 Regular Sample Form

Date:_________________________

First Name: ______________________________________Last Name: _______________________________________

Street Address:_______________________________________________________________________________________

City:__________________________________________ State: ____________________ Zip Code:__________________

Phone Number:_______________________________________________

Email:__________________________________________________________

Amount:_______________________________________________________

Sample Information

Fecha: September 12, 2011

Nombre: Pilar Apellido: Rosas López

Dirección de la calle: 1258 Town Farm Road

Ciudad: Chelsea Estado: Vermont (VT) Código Postal: 05038

Número de Teléfono: 802-522-3498

Cantidad: $500 USD

 “Scrambled” Sample Form

Amount:_______________________________________________________ Zip Code:____________________________

Street Address:________________________________________________Date:_________________________________

Last Name: _______________________________________ State:_____________________________________________

Phone Number:_______________________________________________________________________________________

First Name: ______________________________________ City:_______________________________________________

Email:_______________________________________________________

Sample Information

Fecha: January 23, 2011

Nombre: Eduardo Apellido: García de la Cruz

Dirección de la calle: 565 Brook Road

Ciudad: Braintree Estado: Vermont (VT) Código Postal: 05060

Número de Teléfono: 802-505-3105

Cantidad: $350 USD

 Filling Out a Form Date: ____________________________
Pre‐Assessment Name: ____________________________

Circle the correct answer.

1. When might you need to fill out a a. at the dentist or the doctor’s office
form? b. when you send money to your
family or friends
c. when you send a package or letter
d. all of the above

2. Amount means the place you True False

would like to send your money or
package.

3. What information might you need a. your first name and last name
when filling out a form? b. your current phone number and
address
c. your birth date
d. all of the above

4. Is date of birth the same as Yes No

today’s date?

5. Should you write down all of the Yes No

information you will need and
bring it with you to the store, post
office or doctor’s office?

Total Correct:_______

Developed by UVM Extension, Vermont Migrant Education Program, with funding from the Strategies, Opportunities
and Services to Out of-School Youth (SOSOSY) Migrant Education Program Consortium Grant (2013).
 Llenado de Formularios Fecha: ____________________________
Pre‐Evaluación Nombre: ____________________________

Circula la respuesta correcta.

1. ¿En qué situaciones tendrías que a. en el consultorio médico

llenar un formulario? b. cuando envías dinero
c. cuando envías un paquete o una
carta
d. todos los anteriores

2. Cantidad significa el lugar a donde Verdadero Falso

quieres enviar dinero o un paquete.

3. ¿Qué información podrías necesitar al a. tu nombre y apellido

llenar un formulario? b. tu número telefónico y dirección
actual
c. tu fecha de nacimiento
d. todos los anteriores

4. ¿La fecha de nacimiento significa lo Sí No

mismo que la fecha del día de hoy?

5. ¿Debes anotar toda la información Sí No

que necesitas y llevarla contigo a la
tienda, oficina postal o consultorio
médico?

Total de Aciertos:_______

Developed by UVM Extension, Vermont Migrant Education Program, with funding from the Strategies, Opportunities
and Services to Out of-School Youth (SOSOSY) Migrant Education Program Consortium Grant (2013).
 Filling Out a Form Date: ____________________________
Post‐Assessment Name: ____________________________

Circle the correct answer.

1. When might you need to fill out a a. at the dentist or the doctor’s office
form? b. when you send money to your
family or friends
c. when you send a package or letter
d. all of the above

2. Amount means the place you True False

would like to send your money or
package.

3. What information might you need a. your first name and last name
when filling out a form? b. your current phone number and
address
c. your birth date
d. all of the above
4. Is date of birth the same as Yes No
today’s date?

5. Should you write down all of the Yes No

information you will need and
bring it with you to the store, post
office or doctor’s office?

Write your complete address including your first name, last name, street
address or post office box, city, state, and zip code. Include your email
address. (not scored) ____________________________________________
_____________________________________________________________
_____________________________________________________________
Total Correct:_______

Developed by UVM Extension, Vermont Migrant Education Program, with funding from the Strategies, Opportunities
and Services to Out of-School Youth (SOSOSY) Migrant Education Program Consortium Grant (2013).
 Llenado de Formularios Fecha: ____________________________
Post‐Evaluación Nombre: ____________________________

Circula la respuesta correcta.

1. ¿En qué situaciones tendrías que a. en el consultorio médico

llenar un formulario? b. cuando envías dinero
c. cuando envías un paquete o una
carta
d. todos los anteriores

2. Cantidad significa el lugar a donde Verdadero Falso

quieres enviar dinero o un paquete.

3. ¿Qué información podrías necesitar al a. tu nombre y apellido

llenar un formulario? b. tu número telefónico y dirección
actual
c. tu fecha de nacimiento
d. todos los anteriores

4. ¿La fecha de nacimiento significa lo Sí No

mismo que la fecha del día de hoy?

5. ¿Debes anotar toda la información Sí No

que necesitas y llevarla contigo a la
tienda, oficina postal o consultorio
médico?

Escribe tu dirección completa incluyendo tu nombre, apellido, nombre de la

calle y número, o número de tu apartado postal, ciudad, estado, y código
postal. Incluya su dirección de correo electrónico. (no calificar)
_____________________________________________________________
_____________________________________________________________
Total de Aciertos:_______

Developed by UVM Extension, Vermont Migrant Education Program, with funding from the Strategies, Opportunities
and Services to Out of-School Youth (SOSOSY) Migrant Education Program Consortium Grant (2013).