DATA GATHERING INSTRUMENT FOR TRAINEE’S CHARACTERISTICS

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 English Math
(LL&N) 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
a. 75 to 79 e. 75 to 79
Cultural and Ethnicity/culture:
language a. Ifugao
background
b. Igorot
c. locano
d. Ibanag
e. Gaddang
f. Muslim
g. Ibaloy
h. Tagalog
i. Others( please specify)_____________

Education & Highest Educational Attainment:

general knowledge a. High School Level
b. High School Graduate
c. College Level
Others( please specify): ________________
Sex a. Male
b. Female
Age Your age: 47

Document No.
Date Developed: Issued by:
JULY 2022
MASSAGE THERAPY NC
II
Page |1
PERFORM BODY Developed by: Revision # 01
IMEE P. GUITILEN
MASSAGE
Physical ability 1. Disabilities(if any)_____________________
2. Existing Health Conditions (Existing illness if any)
a. None
b. Asthma
c. Anemia
d. Hypertension
e. Others(please specify) ___________________
MASSAGE THERAPY NC II Related Certificates
Previous
experience with a. Therapeutic Massage
the topic b. Own Wellness Massage
c. Pregnancy Massage
d. Others(please specify): ______________

Number of years as a Massage Therapy: 13 years

List down trainings related to Massage Therapy:
Previous learning
experience • Accupressure (Shiatsu)
• Thai Massage
• Therapeutic Massage Training
• Lactation Massage

National Certificates acquired and NC level

Training Level
completed • MASSAGE THERAPY NC II

Other courses related to Massage Therapy

Special courses
a. Units in Midwifery
b. Others(please specify):
BS in Midwifery

Document No.
Date Developed: Issued by:
JULY 2022
MASSAGE THERAPY NC
II
Page |2
PERFORM BODY Developed by: Revision # 01
IMEE P. GUITILEN
MASSAGE
 Learning styles 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.
d. Activist - Learns by having a go
e. Reflector - Learns most from activities where they
can watch, listen and then review what has
happened.
f. Theorist - Learns most when ideas are linked to
existing theories and concepts.
g. Pragmatist - Learns most from learning activities
that are directly relevant to their situation.
a. Financially challenged
Other needs
b. Working student
c. Solo parent
d. Others(please specify)
___________________________

Document No.
Date Developed: Issued by:
JULY 2022
MASSAGE THERAPY NC
II
Page |3
PERFORM BODY Developed by: Revision # 01
IMEE P. GUITILEN
MASSAGE