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Republic of the Philippines

Department of Education
Region XII
Division of South Cotabato
T’BOLI II DISTRICT
LUBIYA ELEMENTARY SCHOOL

EARLY CHILDHOOD DEVELOPMENT CHECKLIST


SY 2021-2022

Name of Learner _______________________________________ Birthdate _______________


Address _______________________________________ Age _______________
Parent/Guardian _______________________________________ Sex _______________

Beginning of School Year End of School Year


Domain
Raw Scaled Raw Scaled
Score Score Interpretation Score Score Interpretation
Gross Motor
Fine Motor
Self-Help
Receptive Language
Expressive Language
Cognitive
Socio-Emotional
Sum of Scaled Score
Standard Score
Overall Interpretation

Name of Teacher/Adviser AMIEGRACE L. GALIT Signature _______________

Interpretation of Scaled Score


Scaled Score CODE Interpretation
69 and below SSGDOD Suggest Significant Delay in Overall Development
70 – 79 SSLDOD Suggest Slight Delay in Overall Development
80 – 119 AOD Average Overall Development
120 – 129 SSAD Suggest Slightly Advanced Development
130 and above SHAD Suggest Highly Advanced Development

CERTIFICATION
I certify that this is a true record of ______________________________with
LRN____________________________ and that he/she is eligible for admission to GRADE ONE.

School Name LUBIYA ELEMENTARY SCHOOL


School ID 130828
Division DIVISION OF SOUTH COTABATO
SY last Attended 2022 – 2023

____________________________ LENITA C. LEDESMA


Date HT-II

*Not valid without seal

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