Data Gathering Instrument for Learner's Characteristics

Name: _______________________________________ Date: _____________

Section: _________________________________ Age: _____________

Instruction:
Please answer the following tool according to the characteristics that best describe you as a
learner. Encircle the letter of your choice or use provided blank spaces to write your response.

Language, literacy, and numeracy (LL&N)

Reading Comprehension Writing Skills Solving Math Computer Literacy
a. 95 and above Problems
b. 90 to 94 a. 95 and above a. 95 and a. 95 and above
c. 85 to 89 b. 90 to 94 above b. 90 to 94
d. 80 to 84 c. 85 to 89 b. 90 to 94 c. 85 to 89
e. 75 to 79 d. 80 to 84 c. 85 to 89 d. 80 to 84
e. 75 to 79 d. 80 to 84 e. 75 to 79
e. 75 to 79

Cultural and language Ethnic group: Language Spoken:

background a. Tagalog Please specify:
b. Cebuano __________________
c. Ilocano __________________
d. Hiligaynon __________________
e. Bicolano __________________
f. Waray
g. Moro Tribal group: if any
h. Others: please specify __________________
________________
Sex a. Male b. Female
Education & general Highest Educational Attainment:
knowledge a. Junior High School
b. Senior High School

Physical ability I. Disabilities(if any)_____________________

II. Existing Health Conditions (Existing illness if any)
a. None
b. Asthma
c. Heart disease
d. Anemia
e. Hypertension
f. Diabetes
g. Others(please specify) __________________
Device for learning a. Laptop
online b. Desktop
c. Tablet
d. Smartphone
e. Others (please specify) __________________
Previous learning List down your knowledge about computer
experience a. ____________________________________
 b. ____________________________________
c. ____________________________________

Average time you spend a. 1-3 Hours

studying online b. 3-5 Hours
c. 5-7 Hours
d. 7-10 Hours
e. 10+ Hours
When learning
something new, I need a. Read information and see diagrams about it
to: b. Listen to a lecture or discuss it
c. Try it out, build a model or touch the materials
When I am trying to a. People and things around me
concentrate, I am most b. Sounds and noises I hear around me
distracted by c. Movements or physical activities going on around me
When assembling a. Read the directions and examine the diagram first
equipment, I prefer to b. Listen to someone tell me what to do or talk to me through it
c. Work with the pieces and figured out what to do myself

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 and will
focus better and learn faster in a 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.
Other needs a. Financially challenged
b. Working student
c. Solo parent
d. Others(please specify) _________________________

Prepared by:
Ms. Michaella D. Failon
CSS Learning Facilitator