DEPARTMENT OF EDUCATION
FRUITS OF FAITH SCHOOL INC.
ECCD / KINDERGARTEN EDUCATION RECORD
SY ____________
NAME OF CHILD: ______________________________ LRN : ________________________
AGE : ______ GENDER: [ ] MALE [ ] FEMALE DATE OF BIRTH: __________________
HANDEDNESS: [ ] RIGHT [ ] LEFT PLACE OF BIRTH : ________________________
D O M A I N
CHILD’S AGE: CHILD’S AGE: CHILD’S AGE:
Expressive domain
Expressive domain
Expressive domain
Socio – Emotional
INTERP
Receptive domain
Receptive domain
Receptive domain
Socio – Emotional
Socio – Emotional
Cognitive domain
Cognitive domain
Cognitive domain
Scaled Score
Scaled Score
Scaled Score
Gross motor
Gross motor
Gross motor
RE
Fine motor
Fine motor
Fine motor
Self - Help
Self - Help
Self - Help
TATIO
domain
domain
domain
N
19 19 19
DEVELOPMENT
18 18 18
17 17 17
ADVANCED
16 16 16
15 15 15
14 14 14
13 13 13
12 12 12
DEVELOPM
AVERAGE
10 11 11
9 10 10
ENT
8 9 9
7 8 8
7 7 7
6 6 6
5 5 5
AFTER 3 -6
4 4 4
3 3 3
2 2 2
1 1 1
DATE OF FIRST ADMINISTRATION: ________________________________ AGE: ______________
DATE OF SECOND ADMINISTRSTION: ________________________________ AGE: ______________
DATE OF THID ADMINISTRATION: _________________________________ AGE: ______________
Interpretation of Scaled Score Interpretation of Scaled Score
Scaled Score Interpretation Scaled Score Interpretation
A 1 -3 Significant Delay A 69& BELOW Significant Delay
B 4–6 Significant Delay B 70 – 80 Significant Delay
C 7 – 13 Average Delay C 81 – 119 Average Delay
D 14 – 16 Slightly Advanced D 120 - 129 Slightly Advanced
E 17 - 19 Highly Advanced E 130 & ABOVE Highly Advanced