1

2
3
 PERSONAL INFORMATION SHEET

A. Answer the following questions.

1) What is your complete name?

(First Name) (Middle Name) (Last Name)

2) What is your sex? Check (✓) the corresponding box.

Male Female

3) When is your date of birth?

(Month) (Day) (Year)
4) Where do you live?

(House number/Street) (Barangay) (City/Town) (Province)

5) What is your religion?

6) What is your marital status? Check (✓) the corresponding box.

Single Widow/Widower
Married Separated/Divorced

7) What is your job/occupation?

8) What is your highest educational attainment?

B. Write a paragraph composed of two (2) to three (3) sentences about

yourself, including your interests and ambition.

______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

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 PRE-TEST
FLT LEARNER SCORE SHEET
(Pre-Test)
NAME : DATE:

OVERALL SCORE:

ALS LEVEL :

STRANDS SCORE LEVEL FOR

INTERVENTION
PIS

LS 1 Communication Skills -
English
Multiple Choice

Writing

Listening/Speaking

LS 1 Communication Skills -
Filipino
Multiple Choice

Pagsulat

Pakikinig/Pagsasalita

LS 2 Scientific Literacy and

Critical Thinking Skills

LS 3 Mathematical and
Problem Solving Skills

LS 4 Life & Career Skills

LS 5 Understanding the Self &

Society

LS 6 Digital Citizenship

OVERALL SCORE

NAME & SIGNATURE OF ALS TEACHER:

5
 FLT LEARNER SCORE SHEET
(Post-Test)
NAME : DATE:

OVERALL SCORE:

ALS LEVEL :

STRANDS SCORE LEVEL FOR

INTERVENTION
PIS

LS 1 Communication Skills -
English
Multiple Choice

Writing

Listening/Speaking

LS 1 Communication Skills -
Filipino
Multiple Choice

Pagsulat

Pakikinig/Pagsasalita

LS 2 Scientific Literacy and

Critical Thinking Skills

LS 3 Mathematical and
Problem Solving Skills

LS 4 Life & Career Skills

LS 5 Understanding the Self &

Society

LS 6 Digital Citizenship

OVERALL SCORE

NAME & SIGNATURE OF ALS TEACHER:

6
 ALS Assessment Form 1
INDIVIDUAL LEARNING
AGREEMENT

Name of Learner: Community Learning Center:

Level: BL LE
ae AE JHS Name of ALS Teacher: _________________________________

Directions: Write your learning goals, learning activities or strategies in order to attain these goals, and the timeline.

Review of Learning Goals

Timeline
Learning Activities and (Pagsusuri sa Kasanayang Natutuhan)
Learning Goals Strategies ALS Teacher’s Advice
(Kailan ito Gustong
Matutuhan) Achieved Not Achieved Date of Review (Payo ng Guro sa ALS)
(Kasanayang Gustong Matutuhan) (Mga Pamamaraan sa
Pagkatuto) (Nakamtan) (Hindi Nakamtan) (Petsa ng
Pagsusuri)

Agreement Starting Date: Agreement Finishing Date:

Signature of Learner: Signature of ALS Teacher:

7
 ALS Assessment Form 2

RECORD OF MODULE USE AND MONITORING OF LEARNER’S PROGRESS

Name of Learner: Community Learning Center:

Level: BL LE AE JHS Name of ALS Teacher:

Directions: Write the title of each learning module you accomplished along with learning strand, date started and finished, results in the pre-test
and post-test, other activity/ies you have completed and your own assessment.
ALS
Date
Pre- Post- Other Related Teacher’s
(Petsa) Learner’s Self- ALS Teacher’s Remarks
Test Test Activities Assessment (Puna ng Guro sa ALS)
Title of Learning Module Learning Assessment of
Strand Result Result Accomplished (Pagtatasa ng
(Pamagat ng Modyul) (Resulta ng (Resulta ng Performance
Panimulang Pagtatapos na (Iba pang Gawaing Guro sa ALS)
(Pagtatasa sa Sarili
Pagtataya) Pagtataya) Natapos) Not
Started Finished sa Pagganap) Mastered
(Simula) (Pagtapos) (Natuto) Mastered
(Hindi Natuto)

(Learner’s Signature over Printed Name) (ALS Teacher’s Signature over Printed Name)
Date: Date: ___________________

8
 ALS RPL Form 1

DOCUMENTATION OF LIFE EXPERIENCE

Name of Learner: Community Learning Center: _
Level: BL LE AE JHS Name of ALS Teacher:

(1) About Me
Directions: Kindly write your hobbies, strengths, interests, weaknesses, ambition/s, and a simplesentence about your family on the spaces
provided.

Hobby/ies (Libangan): Strength/s (Kalakasan):

Interest/s (Hilig): Weakness/es (Kahinaan):

_
_

Ambition/s (Mithiin): Write a simple sentence aboutyour family.

(Sumulat ng pangungusap tungkol sa

iyong pamilya.)
 ALS RPL Form 1
(2) Experiences
Directions: Read each of the common daily life experiences listed in the first column. Place a check ( ) in the second column if
you have ever had such similar life experiences. If you havehad a significant life experience not on the list, kindly check
“Others” and specify on the space provided. Use a separate sheet of paper if necessary. Briefly explain the experience in the
third column; indicate when it happened in the fourth column; and specified where it happened in the fifth column.

P
u Where did
t When did you you
What specific
Experience experience it? experience
i
experience/s?
(Karanasan) (Kailan ito it?
f (Anong karanasan ito?)
naranasan?) (Saan ito
y
e
naranasan?)
s
A. Communication (Komunikasyon)
Reading/Viewing (e.g.,
newspaper, internet)
Listening/Speaking (e.g.,
dialogue)
Writing (e.g., note-taking)
Others, please specify:

B. Social Activity (Panlipunang Aktibidad)

Outdoor Activities (e.g.,
engaging in sports, tree
planting, clean-up drive)
Charitable Works (e.g.,
caring for the sick; giving
donation)
Others, please specify:

C. Science (Agham)
Using/Operating Simple
Machines (e.g., inclined
plane; wheel and axle)
Using Electronic Devices
(e.g., electric bike )
 ALS RPL Form 1

Natural Calamities (e.g.,

typhoon, earthquake)
Human-induced Calamities
(e.g., fire; war)
Others, please specify:

D. Numeracy (Matematika)
Money (e.g., counting and
recording the amount of
money earned and spent)
Geometric Shapes/Figures
(e.g., lines, perimeter, angle,
polygon)
Measuring Devices (e.g.,
linear; kilo, kilometers)
Tables, Graphs, and
Statistics (e.g., collecting and
recording data;
reading/interpreting data in a
graph)
Others, please specify:

E. Livelihood (Kabuhayan)
Agri-fisheries (e.g., food
processing; farming)
Industrial Arts (e.g., welding,
plumbing)
Home Economics
(e.g., housekeeping;
bartending )
Handicraft (e,g., basket
weaving, knitting)
Others, please specify:
 ALS RPL Form 1

F. Intrapersonal and Interpersonal Relationships (Pang-unawa sa Sarili at

Pakikipagkapwa)
Positive Sense of Self (e.g.,
learning to know oneself;
self-worth; self-direction)
Family and Community
Solidarity (e.g.,
demonstrating smooth
interpersonal relationships
between and among family
and community members)
Others, please specify:

G. Information and Communications Technology (ICT) (Teknolohiya ng Impormasyon at

Komunikasyon)
Basic Hardware/Software
Operations and File
Management (e.g., operating
a computer and other
computer peripherals;
managing files in a computer)
Common Office Application
Software Packages (e.g.,
word processing;
presentation software)
Mobile Devices
(e.g., operating mobile
phones, smart
devices/wearables, digital
video cameras, etc.)
Others, please specify:

(Learner’s Signature over Printed Name) (ALS Teacher’s Signature over Printed Name)

Date: Date:
 ALS RPL Form 2

RECORD OF TRAINING

Name of Learner: Community Learning Center:

Level: BL LE AE JHS Name of ALS Teacher:

Directions: Write on the columns the required details of the trainings you completed.

Inclusive Dates of
Attendance
Title of the Training Program Skills Learned (Napapabilang na mga Organizer/Sponsor Evidence(s)
(Titulo ng Pagsasanay) (Kakayahang Petsa) (Nag- (Katibayan)
Natutunan) From To organisa/Isponsor)
(Mula) (Hanggang)

(Learner’s Signature over Printed Name) (ALS Teacher’s Signature over Printed Name)

Date: Date________________
 ALS RPL Form 3

SUMMARY OF WORK HISTORY

Name of Learner: Community Learning Center:

Level: BL LE AE JHS Name of ALS Teacher:

Directions: Write the required details of your previous or present work/s in the table below.

Inclusive Dates
Employer and Workplace (Napapabilang na mga Developed Skills and Understanding
Work Description
(Maypagawa at Lugar ng Petsa) (Nalinang na Pang-unawa at
(Paglalarawan ng Trabaho)
Trabaho) From To Kasanayan)
(Mula) (Hanggang)

(Learner’s Signature over Printed Name) (ALS Teacher’s Signature over Printed Name)
Date: Date: __________________________
 Republic of the Philippines
Department of Education
National Capital Region
SCHOOLS DIVISION OF TAGUIG CITY AND PATEROS

Name of Learner: _____________________________ LRN: _______________________

CLC: _________________________________________ LEVEL: ______________________
ALS Presentation Portfolio Initial Evaluation Form
Contents:

PSA Birth Certificate

2 pcs 1x1 ID picture
2 pcs 2x2 ID Picture
Elementary Diploma for JHS Level)
CRITERIA POINTS
1. The presentation portfolio contains evidence of performance in each of the six
learning strands in the ALS K to 12 BEC
• Personal Information Sheet
• Functional Literacy Test result
• Individual Learning Agreement
• Learner’s Record of Module use/Tracking Forms
2. Learning outputs contain evidence of the practical application and
demonstration of capabilities and/or abilities
• RPL Form 1 (Documentary of Life Experience)
• RPL Form 2 (Record of Training Skills)
• RPL Form 3 (Summary of Work History)
• RPL Form 4 (Learner’s Checklist of Skills)
• Compilation of certificates on
activities/seminars/trainings/short-term courses attended (if
3. The any)
contents of the presentation portfolio provide evidence of the learner’s
progress
towards
• Four achieving stated learning
(4) Work Samples for eachgoals
Learning Strand
➢ LS 1 – English
➢ LS 1 – Filipino
➢ LS 2
➢ LS 3
➢ LS 4
➢ LS 5
➢ LS 6
TOTAL SCORE:
REMARKS (PASSED/FAILED):

Certified by: Evaluated by:

_________________________________ AILEEN C. GEÑOSO

ALS Teacher Education Program Specialist II for ALS
Signature over Printed Name Signature over Printed Name