PUPIL’S SOCIO-DEMOGRAPHIC PROFILE

SOCIO- EMOTIONAL BoSY EoSY

Child’s Name: ______________________________
DOMAIN
P O R P O R Sex:_________ Date of Birth:__________________
Republic of the Philippines
Address: __________________________________ Department of Education
1 Region I
Comforts playmates/siblings in distress.
3
Child’s Handedness: (Check Appropriate Box) Schools Division of Ilocos Sur
1 Persists when faced with a problem or obstacle to his Right Left Not yet established Tagudin District
4 wants. TAGUDIN CENTRAL SCHOOL
1 Helps with family chores(e.g. wiping tables, watering Father’s Name: ______________________________ 100780
5 plants) S.Y. 2020-2021
Occupation:_________________________________
1 Curious about environment but knows when to stop Educational Attainment: _______________________
6 asking questions to adult.
Mother’s Name:______________________________
1
7
Waits for turns. Occupation:_________________________________
Educational Attainment: ______________________
1 Asks permission to play with toys being used by Form 2
8 others.
SUMMARY OF ASSESSMENT EARLY CHILDHOOD
1
9
Defends possessions with determination.
DEVELOPMENT CHECKLIST
BoSY EoSY
2 Plays organized group games fairly(e.g. does not (Pupil Rating Sheet)
YR MO Day YR MO Day
0 cheat in order to win).
2 Can talk about difficult feelings (e.g. anger, sadness, Date Assessed
1 worry) he experience. Child’S Date of
Birth
2 Honors a simple bargain with caregiver (e.g., can
2 play outside only after cleaning/fixing his room) Pupil’s Age
Domains RS SC RS SC
2 Watches responsibly over younger siblings/family
3 members. Gross-Motor
2 Cooperates with adults and peers in group situations Fine Motor
4 to minimize quarrels and conflicts.
Self-Help Name:
Total Score Receptive Language
Expressive Language
__________________________________________
Cognitive Sex: __________________
Interpretation of Scaled Score
Scaled Score Interpretation Socio-emotional Birthday: __________________
1-3 Development in the domain must be monitored after 3 months Sum of Scaled Scores
4-6 Development in the domain must be monitored after 6 months LRN: -
7-13 Average development Standard Score
14-16 Suggest slightly advanced development INTERPRETATI
17-19 Suggest highly advanced development
ON To the Parents:
Parent’s / The Philippine Early Childhood Care and
Standard Score Equivalent Development Checklist (Form 2) contains knowledge, skills,
Guardian’s
and attitudes of children 3 – 5.11 years old. This may be used
Scaled Standard Scaled Standard Scaled Standard Scaled Standard Scaled Standard Scaled Standard Signature
Score Score Score Score Score Score Score Score Score Score Score Score as a guide in knowing your child and consequently give
29 37 41 54 53 72 65 89 77 107 89 124
Interpretation of Standard Score or Development Index appropriate care and teaching to guide their growth and
30 38 44 56 54 73 66 91 78 108 90 126 Standard development.
Interpretation
31 40 43 57 55 75 67 92 79 110 91 127 Score
32 41 44 59 56 76 68 94 80 111 92 129 69 and below Suggest significant delay in overall development
33 43 45 60 57 78 69 95 81 113 93 130 70-79 Suggest slight delay in overall development
34 44 46 62 58 79 70 97 82 114 94 132 80-119 Average overall development ANNABEL T. ABAD
35 45 47 63 59 81 71 98 83 116 95 133 120-129 Suggest slightly advanced development Kindergarten Teacher
36 47 48 65 60 82 72 100 84 117 96 135
130 and above Suggest highly advanced development
37 48 49 66 61 84 73 101 85 119 97 136
38 50 50 67 62 85 74 103 86 120 98 138
39 51 51 69 63 86 75 104 87 122 99 139 CHERRY MAY L. HERNANDO
40 53 52 70 64 88 76 105 88 123 100 141 Principal II
 GROSS MOTOR DOMAIN BoSY EoSY 9 Drinks from cup unassisted. P- Present O-Observed R- Reported by
P O R P O R 10 Gets drink for self unassisted. parent/guardian
1 Climbs on chair or elevated piece of furniture like a 11 Pours from pitcher without spillage.
bed without help
12 Prepares own food/snacks. COGNITIVE DOMAIN BoSY EoSY
2 Walks backward. P O R P O R
13 Prepares meals for younger siblings/ family members 1 Looks at direction of fallen object
3 Runs without tripping or falling. when no adult is around.
Walks down stairs, 2 feet on each step, with one 2 Looks for partially hidden object
4 14 Participates when being dressed.
hand held. 3 Imitates behavior just seen a few minutes earlier
Walks upstairs holding handrail, 2 feet on each step. 15 Pulls down gartered short pants.
5 4 Offers object but will not release it
Walks upstairs with alternate feet without holding 16 Removes sando.
6 5 Looks for completely hidden object
handrail. 17 Dresses without assistance except buttons and tying.
7 Walks downstairs with alternate feet without holding 6 Exhibits simple pretend play (feed, put doll to sleep)
handrail. 18 Dresses without assistance including buttons and tying.
7 Matches objects
8 Moves body part as directed. Informs the adult only after he has already urinated
19 (peed) or moved his bowels (pooped) in his 8 Matches 2 – 3 colors
9 Jumps up
underpants.
9 Matches pictures
1 Throws ball overhead with direction. Informs adult of need to urinate (pee) or move bowels
20 (poop) so he can be brought to a designated place 1 Sorts objects based on 2 attributes (e.g., size and
0 color)
(e.g. comfort room) 0
1 Hops 1 to 3 steps on preferred foot. Sorts objects based on 2 attributes (e.g.,shape and
Goes to the designated place to urinate (pee) or move 1
1 21 bowels (poop) but sometimes still does this in his 1 color)
1 Jumps and turns. underpants. 1 Arranges objects according to size from smallest to
Goes to the designated place to urinate (pee) or move 2 biggest
2 22 bowels (poop) and never does this in his underpants 1 Names 4 – 6 colors
1 Dances patterns/joins group movement activities. anymore 3
3 23 Wipes/Cleans self after a bowel movement (poop) 1 Copies shapes
Participates when bathing (e.g. rubbing arms with 4
Total Score 24
soap) 1 Names 3 animals or vegetables when asked
Washes and dries hands without any help. 5
25 1 States what common household items are used for
BoSY EoSY 26 Washes face without any help. 6
FINE MOTOR DOMAIN 27 Bathes without any help. 1 Can assemble simple puzzles
P O R P O R 7
Uses all five fingers to get food/toys placed on flat surface. Total Score
1 1 Demonstrates an understanding of opposites by
Picks up objects with thumb and index finger. 8 completing a statement (e.g., Ang aso ay malaki, ang
2 daga ay _____”)
Displays a definite hand preference.
3 BoSY EoSY 1 Points to left and right sides of body
Puts small objects in/out of containers. RECEPTIVE LANGUAGE 9
4 P O R P O R
2 Can state what is silly or wrong with pictures (e.g. Ano
Holds crayon with all fingers of his hand making a fist (i.e. 1 Points to family member when asked to do so ang mali sa larawang ito?)
0
5 palmar grasp) 2 Points to 5 body parts on himself when asked to do so 2 Matches upper and lower case letters
6 Unscrews lid of container or unwraps food. 3 Points to 5 named pictured objects when asked to do so 1
Scribbles spontaneously. 4 Follows one-step instructions that include simple
7 Total Score
prepositions (e.g., in, on, under, etc.)
8 Scribbles vertical and horizontal lines.
5 Follows 2-step instructions that include simple
9 Draws circle purposely. prepositions
Draws a human figure (head, eyes, trunk, arms, Total Score BoSY EoSY
10 hands/fingers)
SOCIO-EMOTIONAL DOMAIN
P O R P O R
11 Draws a house using geometric forms.
Enjoys watching activities of people or nearby
1
Total Score BoSY EoSY animals.
EXPRESSIVE LANGUAGE P O R P O R Friendly w/ strangers but may initially show slight
2
Uses 5-20 recognizable words shyness.
1
SELF HELP DOMAIN BoSY EoSY Plays alone but likes to be near to familiar adults or
2 Uses pronouns (e.g. I, me, ako, akin) 3
brother and sister.
P O R P O R 3 Uses 2-3 words verb-noun combinations (e.g. hingi 4 Laughs or squeals aloud in play.
1 Feeds self with finger foods (e.g. biscuits, bread) using gatas)
fingers. 4 Names objects in pictures 5 Plays peek-a-boo (bulaga).
2 Feeds self using fingers with spillage. 5 Speaks in grammatically correct 2-3 word sentences 6 Rolls ball interactively with caregiver/ examiner.
3 Feeds self using spoon with spillage. 6 Asks “what” questions 7 Hugs or cuddles toys.
Feeds self using fingers without spillage. 7 Asks “who”' and “why” questions
4 8 Demonstrates respect for elders using “po” and “opo”.
8 Gives account of recent experiences (with prompting) in
5 Feeds self using spoon without spillage. order of occurrence using past tense Shares toys with others familiar adults or brother and
9
sister.
6 Eats without need for spoon feeding during any meal. Total Score
10 Imitates adults activities (e.g. cooking, washing)
7 Helps hold cup for drinking.
8 Drinks from cup with spillage. 11 Identifies feelings of others.
 Appropriately uses cultural gestures of greetings
12
without much prompting( e.g. mano/bless, kiss, etc.)