Documente Academic
Documente Profesional
Documente Cultură
Address: __________________________________________________________________
SUMMARY OF RESULTS (Barangay) (Municipality/City) (Province) (Region)
PRE Evaluation POST Evaluation
Child’s Handedness: (check) ____ Right ____ Left ____ Both not yet establish
DOMAIN Raw Scaled Raw Scaled
Score Score Score Score Father’s Name: ___________________________________ Father’s Age: ________
GROSS MOTOR
Father’s Occupation: ___________________________________________________
FINE MOTOR
Father’s Educational Attainment: ______________________________________
SELF-HELP
RECEPTIVE LANGUAGE Mother’s Name: __________________________________ Mother’s Age: ________
EXPRESSIVE LANGUAGE Mother’s Occupation: __________________________________________________
COGNITIVE
Mother’s Educational Attainment: ______________________________________
SOCIAL-EMOTIONAL
Child’s Number of Siblings: _____________________________________________
Sum of Scaled Scores
COMPUTATION OF CHILD’S AGE
Standard Score Examiner’s
Date Tested Year Month Day Name
Date Tested
Pre
PREPARED BY: Evaluation Child’s Date of Birth
________________________ Child’s Age
KINDERGARTEN TEACHER
APPROVED BY: Post Date Tested
LEMUEL S. DELA VEGA
Evaluation Child’s Date of Birth
Child’s Age
Principal 1
REVISED ECCD CHECKLIST