Data Gathering Instrument for Trainee’s Characteristics

Name: ________________________________

Please answer the following instrument according to the characteristics

described below. Encircle the letter of your choice that best describes you as a
learner. Blank spaces are provided for some data that need your response.

Characteristics of Learners

Language, literacy Average grade in: Average grade in:

and numeracy (LL&N) English Math
a. 95 and above a. 95 and above
b. 90 to 94 b. 90 to 94
c. 85 to 89 c. 85 to 89
d. 80 to 84 d. 80 to 84
e. 75 to 79 e. 75 to 79
Cultural and language Ethnicity/culture:
background a. Ilocano
b. Cebuano
c. Tagalog
d. Ilonggo
e. Muslim
f. Others please specify)
Education & general Highest Educational Attainment:
knowledge a. High School Level
b. High School Graduate
c. College Level
d. College Graduate
e.
Sex a. Male
b. Female

Age
Your age:

Physical ability
a. Existing Health Condition
Asthma
Heart disease
Anemia
Hypertension
Diabetes
Others (please specify) ___________
 Characteristics of Learners

Previous Work Work Duration

experience related to a. none
the Housekeeping b. 1 year
c. 1 year - more
NCII
d. 2 year-more

Previous learning List down trainings/seminar

experience a.
b.

Learning style Please refer to the previous learning style assessment

a. Visual
b. Auditory
c. Kinesthetic
Other needs a. Financially challenged
b. Working student
c. Solo parent
d. Others (please specify) __________________