1st 2nd 3rd

ADMINISTRATION Administration Administration Administration

JULY OCTOBER FEBRUARY Republic of the Philippines

Total Scaled Score:
Parents Signature Department of Education
Standard Score: Region XI
Division of Davao Oriental
Interpretation: BAGANGA NORTH DISTRICT
First Administration: ____________________________
SAN VICTOR ELEMENTARY SCHOOL
INTERPRETATION OF STANDARD SCORE AND DEVELOPMENT INDEX Second Administration: ____________________________ S.Y. 2016-2017
STANDARD SCORE INTERPRETATION
Third Administration: ____________________________
69 and below Suggest significant delayed in overall
development
70-99 Suggest slight delayed in overall PHILIPPINE EARLY CHILDHOOD
development Certificate of Completion
100-119 Average over all development CARE AND DEVELOPMENT (ECCD)
120-129 Suggest slightly advanced development
130 and above Suggest highly advanced development
This is to certify that CHECKLIST
(5 years old)

NUMBER OF DAYS IN ATTENDANCE Has completed the Kindergarten

J J A S O N D J F M T Curriculum as prescribed by the Department of Education,
U U U E C O E A E A O
School Year 2016-2017.
N L G P T V C N B R T Name
E Y T A
L
_________________
LRN
No. of AIZA D. POQUITA
School 14 21 22 22 21 20 15 22 20 23 200 Kindergarten Teacher
Days
Birthdate: 12/25/2009 Age: 6.6
No. of
Days Noted by: Handedness: Left Right Both Sex: F
Present
No. of MERLYN L. MONDAY Address: Ubian, SanVictor Bga. Dvo. Or
Days School Head
Tardy
 COGNITIVE DOMAIN
GROSS MOTOR DOMAIN COGNITIVE DOMAIN 1st 2nd 3rd Comment
1. Look at direction of fallen objects.
GROSS MOTOR DOMAIN 1st 2nd
3rd
Comment
DRESSING SUB-DOMAIN 1st 2nd 3rd Comment 2. Look for partially hidden objects.
1. Climbs on chair or other elevated piece of 14. Participates when being dressed (e.g. raises arms, 3. Imitates behavior just seen a few minutes earlier.
furniture like a bed without help. lifts leg). 4. Offers objects but will not release it.
2. Walks backwards. 15. Pulls down gartered short pants. 5. Looks for completely objects.
3. Runs without tripping or falling. 16. Removes sando. 6. Exhibits simple pretend play (feed, put doll to sleep)
4. Walks downstairs, 2 feet on each step, 17. Dresses without assistance. 7. Matches objects.
with one hand held. 18. Dresses without assistance including buttons 8. Matches 2-3 color.
5. Walks upstairs holding handrail , 2 feet on and tying. 9. Matches pictures.
each step. TOILET TRAINING SUB-DOMAIN 10. Sorts based on shapes.
6. Walks upstairs with alternate feet w/o 19. Inform adults only after he/she has already 11. Sorts objects based on 2 attributes (e.g. size& colors).
holdinghandrail. urinated(peed) or move his/her bowel (poohed) in his 12. Arrange objects according to size from smallest to biggest.
7. Walks downstairs with alternate feet w/o underpants. 13. Names 4-6 colors
holding handrail. 20. Informs adults to urinate (pee) or move bowels 14. Copies shapes.
8. Moves body parts as directed. (pooh)so he can be brought to a designated place(e.g. 15. Names 3 animals or vegetables when asked.
9. Jumps Up. comfort room). 16. States what common household items are used for.
10.Throws ball overhead with direction. 21. Goes to the designated place to urinate (pee) or 17. Can assemble simple puzzles.
move bowels(pooh) and never does this in his
11. Hops 1 to 3 steps on preferred foot. 18. Demonstrates an understanding of opposites by completing a
underpants anymore. statement (e.g. Angaso ay malaki, angdaga___)
12. Jumps and turns.
22. Goes to the designated place to urinate (pee) or 19. Points to left and right slides of body.
13. Dances patterns/joins group movement
move bowels(pooh) and never does this in his 20. Can state what is silly or wrong with pictures (e.g.
activities.
underpants anymore. Anoangmalisalarawangito?)
TOTAL SCORE:
23. Wipes/cleans self after bowel movement (pooh). 21. Matches upper case and lower case letters.
FINE MOTOR DOMAIN
24. Participates when bathing (e.g. rubbing arms with TOTAL SCORE:
FINE MOTOR DOMAIN 1st 2nd 3rd Comment
soap). SOCIAL EMOTIONAL DOMAIN
1. Uses all five fingers to get food/toys placed on flat
surface. 25. Washes and dries hands without any help. SOCIAL-EMOTIONAL DOMAIN 1st 2nd 3rd Comment
2. Picks up objects with thumbs and index fingers. 26. Washes face without any help. 1. Enjoys watching activities of nearby people or animals.
27. Bathes without any help. 2. Friendly with strangers but initially may show slight anxiety or
3. Displays a definite hand preference.
TOTAL SCORE: shyness.
4. Puts small objects in/out of containers. 3.Plays alone but like to be near with familiar adults or brothers
RECEPTIVE LANGUAGE DOMAIN
5. Holds crayon with all fingers of his hand making a and sisters..
RECEPTIVE LANGUAGE DOMAIN 1st 2nd 3rd Comment
fist (i.e. palmer grasp) 4. Laughs or squeals aloud in play
1. Points to family member when asked to do so.
6. Unscrew slid of container or unwraps food. 5. Plays peek-a-boo (bulaga).
2. Points to 5 body parts on himself when asked to do
7. Scribbles spontaneously. 6. Rolls a ball interactively.
so.
8. Scribbles vertical and horizontal lines. 7. Hugs or cuddles toys.
3. Points to 5 named pictured objects when asked to
9. Draws circle purposely. 8. Demonstrates respect for elders using terms like poand Opo
do so.
10.Draws a human figure (hand, eyes, trunk, arms, 9. Shares toys with others.
4. Follow one step instruction that include simple
and hands/fingers). 10.Imitates adults activities (e.g.cooking, washing).
preposition.
11. Hops 1 to 3 steps on preferred foot. 11.Identifies feeling of others.
5. Follow two step instruction that include simple
12. Jumps and turns. 12.Appropriately uses cultural gestures of greetings without much
preposition.
13. Draws a house using geometric forms. prompting (e.g. mano, bless, kiss, etc..)
TOTAL SCORE: 13. Comfort playmates /sibling in distress.
TOTAL SCORE:
EXPRESSIVE LANGUAGE DOMAIN 14. Persist when faced with a problem or obstacles to his wants.
SELF-HELP DOMAIN EXPRESSIVE LANGUAGE DOMAIN 1st 2nd 3rd Comment 15. Helps with family chores (e.g. wiping tables, watering plants).
SELF HELP DOMAIN 1st 2nd 3rd Comment 1.Uses 5-20 recognizable words. 16.Curios about environment but knows when to stop asking
1. Feeds self with finger food(e.g. biscuit, bread)
2.Uses pronouns (e.g. I, me, ako, akin) question of adults.
using finger. 17. Waits for turn.
3.Uses 2-3 words verb-noun combination (e.g.
2. Feeds self-using finger with spillage. 18. Ask permission to play with toy being used by others.
hingigatas).
3. Feeds self-using spoon with spillage. 19. Defends possessions with determination.
4. Names objects in pictures.
4. Feeds self-using finger w/o spillage. 20. Plays organized group games fairly (e.g. does not cheat in order
5.Speaks in grammatically correct 2-3 words to win).
5. Feeds self-using spoon w/o spillage. sentence. 21.Can talk about difficult feelings (e.g. anger, sadness, worry)he
6. Eats w/o need for spoon feeding during any meal. 6.Ask what questions. experiences.
7. Helps hold cup for drinking. 7. Ask who and why questions. 22. Honors a simple bargain with caregiver (e.g. can play outside
8. Drinks from cup with spillage. 8. Gives account of recent experiences(with only after cleaning/finishing his room.
23.Watches responsibly over younger siblings/family members.
9. Drinks from cup unassisted. prompting)in order of occurrence using past tense.
24.Cooperates with adults and peers in group situation to minimize
10. Gets drink for self-unassisted. TOTAL SCORE: quarrels and conflicts.
11. Pours from pitcher without spillage. TOTAL SCORE:
12. Prepares own food for snack.
13. Prepares meal for younger siblings/family
members when no adult is around.