NATIONAL EDUCATION TESTING & RESEARCH CENTER

LANGUAGE ASSESSMENT FOR PRIMARY GRADES

Answer Sheet

OF EDUCATION

DEPARTMENT

NAME:
LAST NAME

FIRST NAME

MI

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DIV

REG

SCHOOL ID

4A

D1

4B

D2

10

11

12

NCR

CAR

ARMM

CARAGA

YES

FOR THOSE IN PUBLIC

SCHOOLS ONLY:
Do you belong to a
section with Special
Science Curriculum?
YES
NO

DONT KNOW

NO

NUMBER OF SHIFTS PER DAY (G3)

TYPE OF
COMMUNITY
U
R

ELEMENTARY SCHOOL TYPE

Central / Pilot Elementary School
Non-Central Elementary School
Primary School

MONTH
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
NOV
DEC

Multi-Grade School
State College/University ES
Madaris School

C
O
D
E

GENDER
Boy
Girl

LATEST
GRADE
YEAR

How many are

you in your
class/section?

English Filipino

MARKING INSTRUCTIONS
Use No. 1 or No. 2 pencil only.
Do not use ink, ballpoint or felt tip pens.
Make solid marks that fill the response
completely.
Erase cleanly any marks you wish to change.
Make no stray marks on this form.

EXAMPLE
RIGHT
A

WRONG
D

EXAMINEE'S DESCRIPTIVE QUESTIONNAIRE (EDQ)

1.
2.
3.
4.
5.

AGE

DAY

Urban
Rural

B
A
R

BIRTHDATE

LEARNER REFERENCE NUMBER (LRN)

Is your family a
recipient of Pantawid
Pamilya Pilipino
Program?

EXAMINEE NO.

6.
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11.

Check

ENGLISH
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FILIPINO

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MOTHER TONGUE

I HEREBY RECOGNIZE THE AUTHORITY OF THE

SECRETARY OF EDUCATION TO EVALUATE MY ANSWER
SHEET IN ACCORDANCE WITH ITS IMPLEMENTING
RULES, REGULATIONS AND PUBLIC POLICY.

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Mother Tongue
Tested:
_________________
Ilokano
Pangasinan
Ibanag
Ivatan
Botolan Sambal
Kapampangan
Bikol
Hiligaynon
Kinaray-a
Akeanon
Sinugbuanong Binisaya
Waray
Chavacano
Surigaonon
Maguindanaon
Meranaw
Tausug
Yakan

EXAMINEE'S SIGNATURE

SCHOOL:
March 2015