Republic of the Philippines

Department of Education
Region IV A CALABARZON
Division of Quezon
Candelaria East District
PAHINGA SUR ELEMENTARY SCHOOL

WRITTEN ASSESSMENT
ENGLISH 5 QUARTER I (WEEK 1 & 2)

Name:________________________________________________ Date: __________________

Grade & Section: ______________________________________ Teacher: ________________

Read each item carefully. Write the letter of the correct answer on the space provided.

___1. The process by which an individual needs to fill out and supply requested information correctly and
accurately on the space provided.
A. filling-out forms B. predicting outcomes C. noting details D. identification
___2. It refers to the card issued by a librarian to individuals or organizations entitling them or their
representatives to borrow materials.
A. library card B. borrower’s card C. identification card D. cash card
___3. It is the particulars of a place where someone lives or an organization is situated.
A. venue B. postal code C. location D. address
___4. What is a printed piece of paper used in bank to withdraw money in cash from one’s account?
A. withdrawal slip B. loyalty card C. deposit slip D. claim slip
___5. To fill out forms accurately, the following are things to remember except one:
Do not write capital letters on the information needed
Look whether you have to write first your last name or your first name.
See whether you need to write only your middle initial or your middle name.
Write N/A or “not applicable” if it does not apply to you.
___6. It is a small paper form that a bank customer includes when depositing funds into a bank account.
A. payment B. deposit slip C. credit card D.
withdrawal slip
___7. This application is filled out when a learner wants to join a specific club like English club, Math club,
etc.
A. Pupil’s Information Sheet C. Co-curricular Application Form
B. Curricular Application Form D. Graduation Form
___8. It is the detailed information about a learner. This form is usually filled out during enrolment period
A. Pupil’s Information Sheet C. Co-curricular Application Form
B. Curricular Application Form D. Graduation Form
___9. It is the face value of a banknote, coin, or postage stamp
A. denomination B. account balance C. numeration D. account Information
___10. It refers to your surname or family name.
A. first name B. last name C. given name D. extension name
___11. These are the essential tools in gathering information.
A. forms B. cards C. papers D. slips

___12. Which of the following is not a school form?

A. Pupil’s Information Sheet C. Co-curricular Application Form
B. Curricular Application Form D. Loyalty Card

Direction: Match the items in Column A with their descriptions in Column B. Write the letters of the
correct answers only in the blanks provided.

Column B

A. This your identity including first name, middle name and family name.
 Column A

______ 1. Citizenship
______ 2. Date
______ 3. Date of Birth
______ 4. Height
______ 5. Name
______ 6. Place of birth
______ 7. Provincial Address
______ 8. Religion
______ 9. Sex
______ 10. Telephone

Direction: Fill out the form correctly based on the given information below.

Your best friend, Jessica C. Santos, is a grade five pupil. She wants to join to your club. She lives at 85
T.A Reyes St Brgy. Aglipay , Mandaluyong City, just near your place. She loves dancing, acting and
singing. Her adviser is Mrs. Amor A. Andal. On October 26, 2020 she will be turning 10 years old. She is
living with her aunt Mrs. Melinda T. Santos. In case of emergency, you can call her on 09223146278. She
asked your help to fill out the form for the Indak Theater Arts Club. Fill out the form correct for your best
friend below.

Republic of the Philippines

Department of Education
Region IV- A CALABARZON
Division of Quezon
Candelaria East District
PAHINGA SUR ELEMENTARY SCHOOL
Candelaria, Quezon
 TABLE OF SPECIFICATION
WRITTEN ASSESSMENT
ENGLISH 5 (WEEK 1 & 2)

No. of Days No. of

Objectives Percentage Item Placement
Taught Items
Fill –out forms accurately
(school forms)
10 30 100% 1-30
EN5WC-IIj-3.7

TOTAL 10 30 100% 30

Prepared by:

Noted: