Republic of the Philippines

Department of Education
DIVISION OF DAVAO CITY
(District)
(School)
(Address)

Name: Grade & Section:

Adviser:
Parents/Guardians’ Name:

Difficulty in Basic Learning and Applying Knowledge Checklist

Please check if
CHARACTERISTICS observed REMARKS INTERVENTION
YES NO
Difficulty learning
1.
connections between
letters and sounds
2. Confused in short words
(at and to)
3.
Letter reversals
4.
Word reversals

5. Frequently adds and/or

forgets letters in a word

6. Difficulty in remembering
simple sequences
7. Difficulty keeping in place
when reading
8. Poor sequencing of
numbers
9.
Poor spelling
10.
Avoids reading aloud

11. Difficulty organizing ideas

to speak or write
12.
Avoids writing tasks

13.
Left and Right confusion

14. Slow to memorize tasks

and math facts

15. Trouble following oral

instructions

16. Appearing restless or

easily distracted

Difficulty in Reading
 Please check if
observed
CHARACTERISTICS REMARKS INTERVENTION
YES NO

Difficulty learning
17.
connections between
letters and sounds

18. Confusing small words,

such as /at/ and /to/

19. Letters reversals, such

as /d / for /b/
20. Word reversals, such as
tip for pit

21. Frequently adds and/or

forgets letters in a word

Remembering simple
22. sequences, for example:
names of people,
telephone numbers

23. Difficulty understanding

rhyming words

24. Recognize words that

begin with the same sound

25. Sit still for a reasonable

period of time

26. Difficulty keeping in place

when reading

27. Poor sequencing of

numbers like (14 for 41)
28.
Poor spelling

29.
Avoids reading aloud

30. Difficulty organizing ideas

to speak or write

31.
Avoids writing tasks

32.
Left and right confusion

33. Slow to memorize

alphabets and math facts

34. Trouble following oral

instruction

35. Appearing restless or

easily distracted.

Difficulty in Writing
Please check if
CHARACTERISTICS observed
REMARKS INTERVENTION
 YES NO
Cramped fingers or
36.
unusual grip on writing
tool

37. Odd wrist, body and paper

position

38.
Excessive erasures

Inconsistencies: mixing
print/cursive and
39.
upper/lower case letters,
irregular shapes, sizes or
slant of letters

40. Unfinished words or

letters

41. Inconsistent position on

page

42. Inconsistent spacing

between letters an words

43. Slow or labored copying

or writing

44.
Misuse of line and margin

45. General illegibility –

despite training

46. Inattentiveness about

details when writing

Frequent need for verbal

47.
cues and use of sub-
vocalizing

Heavy reliance on vision

48.
to monitor what hand is
doing during writing

Slow implementation of
49. verbal directions that
involve sequencing and
planning

Difficulty in Spelling
Please check if
observed
CHARACTERISTICS REMARKS INTERVENTION
YES NO
50. Bizarre spelling and a
 disconnect between the
letters and the words they
make., reversal of letter,
syllables or omission and
additions
51. Grammatical and spelling
interruptions are severe.
Timing issues. Slow in
speed (e.i. most learners
52. can spell it in seconds, but
for learners with might
take it for five to ten
minutes.
Difficulty in Counting & Calculating
Please check if
CHARACTERISTICS observed REMARKS INTERVENTION
YES NO
Has trouble learning to
count and skips over
53. numbers long after kids
the same age can
remember numbers in
right order
Struggles to recognize
54. patterns, such as smallest
to largest or tallest to
shortest

55. Has trouble recognizing

number symbols

Doesn’t seem to
understand the meaning of
56. counting (when asked for
five blocks, she just hands
you an armful, rather than
counting them out)
Has difficulty learning and
57.
recalling basic math facts,
such as 2 + 4 = 6

58. Struggles to identify +, -

and to use them correctly

May still use fingers to

59. count instead of using
more advanced strategies,
like mental math

Struggles to understand
60. words related to math,
such as greater than and
less than

Has trouble with visual-

61. spatial representations of
numbers, such as number
lines

62. Has difficulty

understanding place value
 Has trouble writing
63. numerals clearly or
putting them in the correct
column.

Has trouble with fractions

64. and with measuring
things, like ingredients in
a simple recipe

65. Struggles to keep score in

sports games
Struggles to apply math
concepts to money
66. including estimating the
total cost, making exact
change and figuring out a
tip
Has a hard time grasping
67.
information shown on
graphs or charts

Has difficulty measuring

68. things like ingredients in a
simple recipe or liquids in
a bottle
Has trouble finding
69.
different approaches to the
same math problem

Evaluator’s Name & Signature Parent/Guardians’ Name & Signature