Barangay: ____________________ Division: ______________________________

CATANDUANES
Municipalit VIRAC Region 5

TOOL FOR MAPPING OF 4-17 YR. OLD CHILDREN

NAME DEMOGRAPHIC INFORMATION RESIDENCE DISABILITY ECCD (FOR 4YO CHILDREN) EDUCATIONAL STATUS FUTURE ENROLLMENT
Provided Planning
With Birth Number If YES, with If YES, specify Currently to study
Date of Is residence Has a If NO, state reason for
Certificate of years specify ECCD ECCD facility Anong Educational studying? If YES, specify name If NO, state reason for If studying through ADM, next If YES, specify the name
Last First Middle Gender Age ?
Present address
in present
permanent? disability?
type of Services? daycare center nag- attainment? (YES/NO of school not studying specify type of ADM school of prospective school
not planning to study
birth (YES/NO) (YES/NO) next school year
(YES/NO) address disability2 (YES/NO aaral? ) year?
) (YES/NO)

1
ASK: "Is the child a permanent resident?" (YES/NO) If YES, follow up "do the residents plan on moving out?"
2
TYPES OF DISABILITIES: (see DepED Order No. 2, s 2014 for detailed descriptions)
1- Visual Impairment 6- Serious emotional disturbance
2- Hearing Impairment 7- Autism INTERVIEWER NAME AND SIGNATURE
3- Intellectual Disability 8- Orthopedic impairment
4- Learning Disability 9- Special health problems
5- Speech/language impairment 10- Multiple disabilities

3
EDUCATIONAL ATTAINMENT:
CK- Completed Kindergarten C7- Completed Grade 7 SK- Some Kindergarten S7- Some Grade 7
C1- Completed Grade 1 C8- Completed Grade 8 S1- Some Grade 1 S8- Some Grade 8
C2- Completed Grade 2 C9- Completed Grade 9 S2- Some Grade 2 S9- Some Grade 9 DATE OF INTERVIEWS
C3- Completed Grade 3 C10- Completed Grade 10 S3- Some Grade 3 S10- Some Grade 10
C4- Completed Grade 4 C11- Completed Grade 11 S4- Some Grade 4 S11- Some Grade 11
C5- Completed Grade 5 C12- Completed Grade 12 S5- Some Grade 5 S12- Some Grade 12
C6- Completed Grade 6 S6- Some Grade 6
 NAME DEMOGRAPHIC INFORMATION RESIDENCE DISABILITY ECCD (FOR 4YO CHILDREN) EDUCATIONAL STATUS FUTURE ENROLLMENT

Number of If YES, Provided Planning to

With Birth Is residence Has a Currently study next If NO, state reason for not
years in 1 specify with ECCD If YES, specify ECCD Educational If YES, specify name of If NO, state reason for If studying through ADM, If YES, specify the name of
Last First Middle Gender Age Date of birth Certificate? Present address present permanent? disability? studying? school planning to study next
(YES/NO) (YES/NO) (YES/NO)
type of Services? facility attainment3 (YES/NO)
school not studying specify type of ADM
year?
prospective school
school year
address disability2 (YES/NO)
(YES/NO)

1
ASK: "Is the child a permanent resident?" (YES/NO) If YES, follow up "do the residents plan on moving out?"

2
TYPES OF DISABILITIES: (see DepED Order No. 2, s 2014 for detailed descriptions)
1- Visual Impairment 6- Serious emotional disturbance
2- Hearing Impairment
3- Intellectual Disability
4- Learning Disability
5- Speech/language impairment
3
EDUCATIONAL ATTAINMENT:
CK- Completed Kindergarten
C1- Completed Grade 1
C2- Completed Grade 2
C3- Completed Grade 3
C4- Completed Grade 4
C5- Completed Grade 5
C6- Completed Grade 6
7- Autism
8- Orthopedic impairment
9- Special health problems
10- Multiple disabilities
C7- Completed Grade 7 SK- Some Kindergarten S7- Some Grade 7
C8- Completed Grade 8 S1- Some Grade 1 S8- Some Grade 8
C9- Completed Grade 9 S2- Some Grade 2 S9- Some Grade 9
C10- Completed Grade 10 S3- Some Grade 3 S10- Some Grade 10
C11- Completed Grade 11 S4- Some Grade 4 S11- Some Grade 11
C12- Completed Grade 12 S5- Some Grade 5 S12- Some Grade 12
S6- Some Grade 6