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Brgy: ____________________________

Team leader: ________________________


I.
Childs Personal Info:
Lastname: ________________________________ Firstname: ____________________________ MI: _____
Address: ___________________________________________________ Age: ______ Sex: __________
Birthdate: ____________ Place: __________________________ Pang-ilan sa magkakapatid: ______________
Father: ________________________________________________ Occupation: _____________________
Mother: ______________________________________________ Occupation: _____________________
Kailan nagsimulang magaral? ________________ Name ng School: ________________________________
Tinuturuan ka ba ng iyong magulang? _________
Activity done: ______________________________________________________________________________
II.
Observation Report: Ilarawan ang sumusunod:
1. Physical:

2. Behavior

3. Health

4. Interest sa pagaaral

III.

Assessment
Interest 5%
_______________
Behavior 5%
_______________
Written Exam 10% _______________
Numerical Skills 20% _______________

IV.

Problems Encountered

V.

Solution or Suggestion

Art Skills 20%


__________________
Writing Skills 20% __________________
Reading Skills 20% __________________
Total: _____________________

Name and Signature


Student tutor: ___________________________________________

Date: ______________________

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