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PUPIL’S SOCIO-DEMOGRAPHIC PROFILE

SOCIO- EMOTIONAL DOMAIN BoSY EoSY
Child’s Name: ______________________________ Republic of the Philippines
P O R P O R Sex:_________ Date of Birth:__________________ Department of Education
Enjoys watching activities of people or nearby Address: __________________________________ Region V
1 Division of Camarines Sur
animals.

2
Friendly w/ strangers but may initially show slight Child’s Handedness: (Check Appropriate Box) Buhi North District
shyness. Right Left Not yet established DE LAFE ELEMENTARY SCHOOL
Plays alone but likes to be near to familiar adults or S.Y. 2022-2023
3
brother and sister.
Father’s Name: ______________________________
4 Laughs or squeals aloud in play.
Occupation:_________________________________
5 Plays peek-a-boo (bulaga).
Educational Attainment: _______________________
6 Rolls ball interactively with caregiver/ examiner. Mother’s Name:______________________________
7 Hugs or cuddles toys. Occupation:_________________________________ Early Childhood Care
Educational Attainment: _______________________ and Development
Demonstrates respect for elders using “po” and
8
“opo”. (ECCD)
Shares toys with others familiar adults or brother and SUMMARY OF ASSESMENT
9
sister.
BoSY EoSY Checklist
10 Imitates adults activities (e.g. cooking, washing) Date Assessed
Pupil’s Age
11 Identifies feelings of others.
Domains RS SC RS SC
Appropriately uses cultural gestures of greetings Gross-Motor
12
without much prompting( e.g. mano/bless, kiss, etc.)
Fine Motor
13 Comforts playmates/siblings in distress. Self-Help
Receptive Language
Persists when faced with a problem or obstacle to his
14
wants. Expressive Language
Helps with family chores(e.g. wiping tables, watering Cognitive
15
plants)
Socio-emotional Name: __________________________
Curious about environment but knows when to stop
16
asking questions to adult. Sum of Scaled Scores Sex: __________________

17 Waits for turns.

Standard Scores Birthday: __________________
RS – Raw Score
Asks permission to play with toys SC
being–used by Score
LRN: -
18 Scaled
others.

19 Defends possessions with determination.

INTERPRETATION
To the Parents:
Plays organized group games fairly(e.g. does not
20 BoSY: The Philippine Early Childhood Care and Development
cheat in order to win).
Checklist (Form 2) contains knowledge, skills, and attitudes of
21
Can talk about difficult feelings (e.g. anger, sadness, children 3 – 5.11 years old. This may be used as a guide in knowing
worry) he experience. your child and consequently give appropriate care and
Honors a simple bargain with caregiver (e.g., can teaching to guide their growth and development.
22
play outside only after cleaning/fixing his room)
Watches responsibly over younger siblings/family
PARENT’S SIGNATURE
23
members.
EoSY: JONAPHEN C. GABALFIN
Cooperates with adults and peers in group situations Teacher
24
to minimize quarrels and conflicts.
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Total Score School Head

PARENT’S SIGNATURE
 6 Eats without need for spoon feeding during any meal. BoSY EoSY
GROSS MOTOR DOMAIN BoSY EoSY 7 Helps hold cup for drinking. RECEPTIVE LANGUAGE P O R P O R
P O R P O R 8 Drinks from cup with spillage. 1 Uses 5-20 recognizable words
1 Climbs on chair or elevated piece of furniture like a
9 Drinks from cup unassisted. 2 Uses pronouns (e.g. I, me, ako, akin)
bed without help 3 Uses 2-3 words verb-noun combinations (e.g. hingi
2 Walks backward. 10 Gets drink for self unassisted. gatas)
3 Runs without tripping or falling. 11 Pours from pitcher without spillage. 4 Names objects in pictures
12 Prepares own food/snacks. 5 Speaks in grammatically correct 2-3 word sentences
4 Walks down stairs, 2 feet on each step, with one
hand held. 6 Asks “what” questions
13 Prepares meals for younger siblings/ family members
5 Walks upstairs holding handrail, 2 feet on each step. when no adult is around. 7 Asks “who”' and “why” questions
6 Walks upstairs with alternate feet without holding 14 Participates when being dressed. 8 Gives account of recent experiences (with prompting)
handrail. in order of occurrence using past tense
15 Pulls down gartered short pants.
7 Walks downstairs with alternate feet without holding Total Score
handrail. 16 Removes sando.
8 Moves body part as directed. 17 Dresses without assistance except buttons and tying.
9 Jumps up 18 Dresses without assistance including buttons and tying.
10 Throws ball overhead with direction. Informs the adult only after he has already urinated
19 (peed) or moved his bowels (pooped) in his
11 Hops 1 to 3 steps on preferred foot.
underpants.
12 Jumps and turns. Informs adult of need to urinate (pee) or move bowels COGNITIVE DOMAIN BoSY EoSY
13 Dances patterns/joins group movement activities. 20 (poop) so he can be brought to a designated place P O R P O R
(e.g. comfort room) 1 Looks at direction of fallen object
Total Score Goes to the designated place to urinate (pee) or move 2 Looks for partially hidden object
21 bowels (poop) but sometimes still does this in his
underpants. 3 Imitates behavior just seen a few minutes earlier
Goes to the designated place to urinate (pee) or move 4 Offers object but will not release it
22 bowels (poop) and never does this in his underpants
anymore 5 Looks for completely hidden object
23 Wipes/Cleans self after a bowel movement (poop) 6 Exhibits simple pretend play (feed, put doll to sleep)
BoSY EoSY
FINE MOTOR DOMAIN 24
Participates when bathing (e.g. rubbing arms with 7 Matches objects
P O R P O R soap) 8 Matches 2 – 3 colors
Uses all five fingers to get food/toys placed on flat surface. 24 Washes and dries hands without any help.
1
9 Matches pictures
2 Picks up objects with thumb and index finger. 26 Washes face without any help.
Displays a definite hand preference.
10 Sorts objects based on 2 attributes (e.g., size and
3 27 Bathes without any help. color)
Puts small objects in/out of containers. Total Score 11 Sorts objects based on 2 attributes (e.g.,shape and
4
color)
Holds crayon with all fingers of his hand making a fist (i.e. 12 Arranges objects according to size from smallest to
5 palmar grasp)
BoSY EoSY biggest
6 Unscrews lid of container or unwraps food.
13 Names 4 – 6 colors
7 Scribbles spontaneously. RECEPTIVE LANGUAGE P O R P O R
8 Scribbles vertical and horizontal lines. 1 Points to family member when asked to do so 14 Copies shapes
9 Draws circle purposely. 2 Points to 5 body parts on himself when asked to do so 15 Names 3 animals or vegetables when asked
Draws a human figure (head, eyes, trunk, arms, 3 Points to 5 named pictured objects when asked to do so 16 States what common household items are used for
10 hands/fingers) 4 Follows one-step instructions that include simple
11 Draws a house using geometric forms. prepositions (e.g., in, on, under, etc.) 17 Can assemble simple puzzles

Total Score 5 Follows 2-step instructions that include simple 18 Demonstrates an understanding of opposites by
prepositions completing a statement (e.g., Ang aso ay malaki, ang
Total Score daga ay _____”)
19 Points to left and right sides of body
20 Can state what is silly or wrong with pictures (e.g. Ano
ang mali sa larawang ito?)
SELF HELP DOMAIN BoSY EoSY 21 Matches upper and lower case letters
P O R P O R
Total Score
1 Feeds self with finger foods (e.g. biscuits, bread) using
fingers.
2 Feeds self using fingers with spillage. P- Present
3 Feeds self using spoon with spillage. O-Observed
4 Feeds self using fingers without spillage. R- Reported by parent/guardian
5 Feeds self using spoon without spillage.