Early Childhood Care and

Development (ECCD)
Checklist

Sociodemographic Profile

Indicate the complete sociodemographic profile of the child.

Child’s Name: ___________________________ Sex: _______ Date of Birth: ________________________

month day year
Address: _______________________________________________________________________________
Barangay Municipality/City Province Region

Child’s Handedness (Check appropriate box)  Right  Left

 Both  Not yet established

Is the child presently studying? (Check appropriate box)  Yes  No

If yes, write name of child’s school/learning center/day care: ____________________________________
Father’s Name _________________________________ Father’s Age: ___________________________
Father’s Occupation: ____________________________ Father’s Educational Attainment: ___________
Mother’s Name _________________________________ Mother’s Age: __________________________
Mother’s Occupation: ____________________________ Mother’s Educational Attainment: __________
Child’s Number of Siblings: ________________________ Child’s Birth Order (1st, 2nd, 3rd, etc.): ________