Department of Labor and Employment

Overseas Workers Welfare Administration

REGIONAL WELFARE OFFICE – MIMAROPA

OFW DEPENDENT SCHOLARSHIP PROGRAM (ODSP)

ASSESSMENT FORM

Name : _______________________________ Batch : _________ Year Level: _______

School : _______________________________ Course : _________________________

I. SCHOOL TERM GRADE

School Year ___________________

Semester : ( ) 1st ( ) 2nd Tri-Semester : ( ) 1st ( ) 2nd ( ) 3rd Quarter : ( ) 1st ( ) 2nd ( ) 3rd ( ) 4th
Special Distinction/Award : ________________________________________________

SUBJECT SUBJECT NO. OF GRADE TOTAL

CODE UNITS

GRAND TOTAL (No. of Units X Grade)

GWA (Grand Total/Total No. of Units)

II. ACADEMIC

1. What was the most important event that has affected you during the school term? How did it affect your
studies?
_______________________________________________________________________________________________
_______________________________________________________________________________________________
____________________________________________________________________ .

2. In what subjects have you given most of your time and attention? Why?
_______________________________________________________________________________________________
_______________________________________________________________________________________________
___________________________________________________________________ .

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3. Are there factors affected your performance in school?
( ) Teacher ( ) Peer Group ( ) Family ( ) Financial ( ) College Life ( ) Love Life ( ) Others
Pls. specify ____
Give reasons on how they have affected you.
_______________________________________________________________________________________________
_______________________________________________________________________________________________
___________________________________________________________________ .

4. Give a brief description on how you can rate your performance for the school term.

I am satisfied. I have done my best during this school term.

I know I could have done more to improve myself.

Please state reason.

_______________________________________________________________________________________________
_______________________________________________________________________________________________
____________________________________________________________________ .

5. What are the assistance under the Learning Support Program have you availed/received during the school
term?
( ) Counselling ( ) Learning Support/Civic Activities Pls. specify ___________________________
( ) Coaching ( ) Group Organizing Pls. specify __________________________
( ) Mentoring ( ) Others Pls. specify ___________________________________
( ) Query/Updates thru Facebook Group Account

6. Did it help you in any way in your studies? ( ) Yes ( ) No

How? Please specify.
_______________________________________________________________________________________________
_______________________________________________________________________________________________
__________________________________________________________________________________________ .

III. NON-ACADEMIC

1. State any extra curricular activities or activities outside the school where you were able to show your
strength/talent.
_______________________________________________________________________________________________
_____________________________________________________________________________ .

2. Did you encounter difficulties in any of the following? (Pls. check)

( ) Family ( ) Financial ( ) Health ( ) Friends ( ) Others Pls. specify _________

How did it affect you?

_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
____________________________________________________________ .

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3. Was there any situation outside the school you applied what you have learned in your studies?

Yes No
Please specify.
_______________________________________________________________________________________________
____________________________________________________________________________________________ .

____________________
Name and Signature

FOR RWO – 4B PURPOSE ONLY

Assessment Remarks :
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_________________________________________________________________________________________ .

Assessed by :

__________________________

Noted :

_________________________
AQUILINA C. TARROBAGO
Chief, PSD