Department of Education

Region VII, Central Visayas

CONTEXTUALIZED MULTI-FACTORED ASSESSMENT TOOL (MFAT)

CONSOLIDATION FORM – MFAT

Division: ____________________ School: ______________________
Name of Assessor:_________________________
LEARNER’S RECOMMENDATIONS
DOMAIN/S ITEM CODE ASSESSMENT ACTIVITY RESPONSES/ASSESSOR’S (To)
(From) OBSRVATIONS

Instructions:
Domain: refers to the learning domain tested
Code: refers to the code of the learning domain
Assessment Activity: Activity given or done in assessing the child as reflected in the assessment tool
Observations: How did the learner respond? What difficulties/ inconveniences did you encounter in doing the activity? What made the activity inappropriate?
What should be done/changed
Form E (Modified)

District/Cluster:_________________

# of Number of Learners with Developmental Delay # of Learners

Learners (Domains) Who are Remarks
School Assessed Developmentally
Advanced
COG COM DLS MS(F&G) SEB

Prepared by:

_____________________________ Noted:
Cluster Head
____________________________
Division SPED Focal Person
Form F (Modified)
District/Cluster: _______________________

# of # of # of # of
Learners Learners Learners #of Learners
# of w/ Intervention/ w/ Intervention/ w/ Intervention/ Learners Intervention/ w/ Intervention/
School Learners Developm Enhancement Developm Enhancement Developm Enhancement w/ Enhancement Developm Enhancement
Assessed ental Program ental Delay Program ental Delay Program Developm Program ental Delay Program
Delay in in in Daily ental Delay in Socio-
Cognitive Communic Living Skill in Motor emotional
Domain ation Skill Skill Skill

Prepared by:

________________________________
District/Cluster Head
Noted:

____________________________
Division SPED Focal Person
Form 1

District/Cluster: _______________________________

# of Learners Who Are

School # of Learners Assessed Developmentally Advanced Intervention/Enhancement Program

Prepared by:

__________________________________
District/Cluster Head

Noted:

__________________________
Division SPED Focal Person