Republic of the PhilippinesDepartment of EducationRegion V – BicolDivision of CatanduanesVirac South DistrictSAN ISIDRO VILLAGE ELEMENTARY SCHOOL

Virac

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Philippine Early Childhood Development Checklist (FORM 2)

AGES 3 YEARS 1 MONTH TO 5 YEARS 11 MONTHSSCHOOL YEAR 2015 – 2016CHILD’S NAME: JENNYLYN BROÑOLA LRN:

174006150011HANDEDNESS: LEFT RIGHT

BOTH UNESTABLISHEDGRADE LEVEL:

KINDERGARTENSEX: ¨ MALE ý

FEMALEBIRTH DATE: 10/27/2009

AGE: 5 Years, 7Months, 6 Days

AS OF: 6/2/2015

CHILD’S ADDRESS:

CHILD’S FATHER:

FATHER’S AGE:

EDUCATIONAL ATTAINMENT:

CIVIL STATUS:

OCCUPATION: CUSTODIAL PARENT:

YES / NOCHILD’S

MOTHER:MOTHER’S

AGE:EDUCATIONAL ATTAINMENT:

CIVIL STATUS:

OCCUPATION: CUSTODIAL PARENT:

YES / NO

AGE OF MOTHER WHEN SHE HAD THE CHILD:

BIRTH ORDER (CHILD): 1ST 2ND

3RD OTHERS: ___GUARDIAN (IF APPLICABLE):

RELATIONSHIP: __________________

TO THE PARENTS: The Philippine Early Childhood Development Checklist (Form 2) contains knowledge, skills and attitudes of children 3 – 5.11 years old. This may be used as a guide in knowing your child and consequently give appropriate care and teaching to guide their growth and development. CONTENT:Every page contains different domains of development with their corresponding total scores: - Gross Motor Domain - Fine Motor Domain has - Self-help Domain

has 13 items 11 items has 27 items- Receptive Language Domain has 5 items - Expressive Language Domain has 8 items - Cognitive Domain has 21 items- Social-Emotional Domain has 24 items

Each item observed are recorded three times within a year: (1) at the start of the year, (2) at the middle of the year, and (3) at the end of the year.COLUMNS SCORE

P- Present or the child can do the taskMM - Present or child is able to do the taskO- Observed or the child was observed doing the taskMM— - Skill is not present or child does not respondR- Report given by the parents/caregiver about the MM 0 - no opportunity to observe the skill

MERLY M. SOMIDOADVISER ARLENE G. DOMINGOSCHOOL PRINCIPAL I