Data Gathering Instrument for Trainee’s Characteristics

NAME OF TRAINEES:____________________________ Date ______________

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.

Name _____________________________ Date: _________________

(Last) (First) (Middle name)

CHARACTERISTICS OF LEARNERS

Language, Literacy and Numeracy (LL&N)

Average grade in Math Average Grade in Reading Average grade in English

a. 95 and above a. 95 and above a. 95 and above
b. 90 to 94 b. 90 to 94 b. 90 to 94
c. 85 to 89 c. 85 to 89 c 85 to 89
d. 80 to 84 d. 80 to 84 d. 80 to 84
e. 75 to 79 e. 75 to 79 e. 75 to 79

Cultural and Language Background

Ethnicity(if any):__________________ Language Spoken:__________________

a. Cebuano
b. Boholano
c. Tagbanwa
d. Waray-waray
e. Surigaonon
f. Kapampangan
g. Others (please specify)________________

Education and General Knowledge

Highest Educational Attainment

a. High School level e. With units in Master’s Degree

b. High School Graduate f. Masteral Graduate
c. College Level g. With units in Doctoral Level
d. College Graduate h. Doctoral Graduate

Sex

a. Male b. Female
Age
Your Age: _________

Physical Ability

1. Disability (if any)_______________

2. Existing Health Conditions (Existing illness if any)
a. None e. Hypertension
b. Asthma f. Diabetes
c. Hearth disease g. Others (Please specify) ___________
d. Anemia
Previous experience with the topic NC Certificates
a. NC certified
b. NC graduate
c. NC Trainer
d. NC Leadtrainer

Previous learning experience

List down trainings attended:

________________________________________________________________
________________________________________________________________

Training Level
National Certificates acquired and NC Level completed
Competency Certificate Number
______________________________ ____________________________
______________________________ ____________________________
______________________________ ____________________________

Special Courses
Other courses
a. Units in Education ____________________
b. Master’s degree units in education ____________________
c. Others (please specify) ____________________

Learning Style

a. Visual – the visual learner takes mental pictures of information given, so in

order for this kind of learner to retain information, oral or written
presentations of new information must contain diagrams and drawings,
preferably in color. The visual learner can’t concentrate with a lot of activity
around him/her and will focus better and learn faster in quiet study
environment.
b. Kinesthetic – described as the students in the classroom, who have
problems sitting still and who often bounce their legs while tapping their
fingers on the desks. They are often referred to as hyperactive students
with concentration issues.
c. Auditory – a learner who has the ability to remember speeches and
 lectures in detail but has a hard time with written text. Having to read long
texts is pointless and will not be retained by the auditory learner unless it is
read aloud.
d. Activist- Learns by having a go.They perceive information concretely and
process it actively. They integrate experience and application. They learn by
trial and error. They believe in self discovery. They are enthusiastic about
new things. They are adaptable, even relish change. They excel when
flexibility is needed. They often reach accurate conclusions in the absence
of logical reason. They are risk takers.
They are at ease with people. They enrich reality by taking what is and
adding to it. Sometimes they are seen as manipulative and pushy.
Their philosophy is: “I’ll try anything once.”
e. Reflector- Learns most from activities where they can watch, listen and
then review what has happened.They perceive information concretely and
process it reflectively. They integrate experience with the Self. They learn
by listening and sharing ideas. They are imaginative thinkers who believe in
their own experience. They excel in viewing direct experience from many
perspectives. They value insightful thinking. They work for harmony. They
need to be personally , seek commitment. Are interested in people and
culture. They are thoughtful people who enjoy observing others. They
absorb reality. They seem to take in the atmosphere almost like osmosis.
Their philosophy is to be cautious, to consider all possible angles and
implications before making a move. “I need more information.”
f. Theorist- Learns most when ideas are linked to existing theories and
concepts. They perceive information abstractly and process it reflectively.
They form theories and concepts by integrating their observations into what
is known. They seek continuity. They need to know what the experts think.
They learn by thinking through ideas. They value sequential thinking. Need
details. They critique information and collect data. They are thorough and
industrious. They will re-examine the facts if situations perplex them. They
enjoy traditional classrooms. Schools are made for them. They are more
interested in ideas then people. They prefer to maximise certainty and are
uncomfortable with subjective judgements.
Their philosophy prizes rationality and logic: “If it’s logical, it’s good.”
g. Pragmatist- Learns most from learning activities that are directly relevant to
their situation.
They perceive information abstractly and process it actively. They integrate
theory and practice. They learn by testing theories and applying common
sense. They are pragmatists, they believe if something works, use it. They
are down-to-earth problem solvers who resent being given answers. They
do not stand on ceremony but get right to the point. They have a limited
tolerance for fuzzy ideas. They value strategic thinking. They are skills-
oriented. They experiment and tinker with things. They need to know how
things work. They edit reality, cut right to the heart of things. Sometimes
 they seem bossy and impersonal.
Their philosophy is: “There is always a better way.” “If it works, it’s good.”

Other needs:

a. Financially challenged
b. Working student
c. Single parent
d. Others ( please specify)_________________

Prepared By:

Jean Cinco

Trainer