Annex 1-Individual Learners Profile

Republic of the Philippines

Department of Education
Region VI- Western Visayas
Schools Division of Iloilo
Schools District of Dueñas
Dueñas Central Elementary School
Poblacion, Dueñas Iloilo

INDIVIDUAL LEARNER’S PROFILE

Part 1

Name: ____________________________________ Date of Birth: ___________ Age: ________

Home Address: ________________________________________________________________
Type of Learner: _________________________________ LRN: _________________________
School Year: ______2022-2023_____________________ Adviser: _Alvin John D. Sablon_____
Principal: _________Vivien L. Lavadia______________________________________________

Type of Date Administered Chronological Age Administrator Results/Outcome

Assessments

Record of Assessments
Attach Records pf Assessment

Interview with Parents/ Guardian

Name of Parent/Guardian: ___________________________________________________________

Contact Number/s: _______________________________ Date of Interview: ___________________

Developmental and Educational History:

_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

Interview with the Learner

Date of Interview: ______________________

Interest/ Hobbies/ Talents:

_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
Annex 1-Individual Learners Profile

DAILY LIVING SKILLS DOMAIN: Present Level of Education Performance

Strength/s: _________________________________________________________________

Need/s: ____________________________________________________________________

LANGUAGE DEVELOPMENT DOMAIN: Present Level of Education Performance

Strength/s: _________________________________________________________________

Need/s: ____________________________________________________________________

PSYCHOMOTOR DOMAIN: Present Level of Education Performance

Strength/s: _________________________________________________________________

Need/s: ____________________________________________________________________

COGNITIVE DOMAIN: Present Level of Education Performance

Strength/s: _________________________________________________________________

Need/s: ____________________________________________________________________

AESTHETIC AND CREATIVE DOMAIN: Present Level of Education Performance

Strength/s: _________________________________________________________________

Need/s: ____________________________________________________________________

BEHAVIORAL DEVELOPMENT: Present Level of Education Performance

Strength/s: _________________________________________________________________

Need/s: ____________________________________________________________________

ORIENTATION AND MOBILITY: Present Level of Education Performance

Strength/s: _________________________________________________________________

Need/s: ____________________________________________________________________
Annex 1-Individual Learners Profile

PART 2

Priority Learning Needs/ Interventions:

1.

_________________________________________________________________________

2. ________________________________________________________________________

3.

_________________________________________________________________________

4.

_________________________________________________________________________

5.

_________________________________________________________________________

Transition Package:

1.

_________________________________________________________________________

2. ________________________________________________________________________

3.

_________________________________________________________________________

4.

_________________________________________________________________________

5.

_________________________________________________________________________