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Name Demographic Information Residence Disability Educational Future Enrollment

This document collects demographic and educational information about an individual. It includes their name, age, gender, date of birth, residence details, educational attainment, disability status, early childhood care and development services received, current and planned future education enrollment. Disability types and educational attainment levels are defined.

Uploaded by

Mark Alvin Jay Carpio
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41 views2 pages

Name Demographic Information Residence Disability Educational Future Enrollment

This document collects demographic and educational information about an individual. It includes their name, age, gender, date of birth, residence details, educational attainment, disability status, early childhood care and development services received, current and planned future education enrollment. Disability types and educational attainment levels are defined.

Uploaded by

Mark Alvin Jay Carpio
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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NAME

Middle

Age

First

Gender

Last

DEMOGRAPHIC INFORMATION

Date of
birth

With
birth
certificat
e?
(Yes/No
)

*Ask: is the child a permanent resident? (YES/NO) If YES, follow up *do the residents plan on
moving out?

RESIDENCE

Present Address

Number
of years
in
present
address

*EDUCATIONAL ATTAINMENT
CK- Completed kindergarten
C1- Completed Grade 1

DISABILITY

Is
residence
permanent
?*
(Yes/No)

Has a
disability
?
(Yes/No)

If YES,
specify
type of
disability*

ECCD (FOR 4 YO
CHILDREN)

Provided
with
ECCD
services?
(Yes/No)

C7- Completed Grade 7


C8- Completed Grade 8

If YES,
specify
ECCD
facility

EDUCATIONAL

Educational
attainment*

Currently
studying?
(Yes/ No)

If YES, specify
name of school

SK- Some Kindergarten


S1- Some Grade 1

FUTURE ENROLLMENT

If NO,
state
reason
for not
studying

If
studying
through
ADM,
specify
type of
ADM

Planning
to study
next
school
year?
(Yes/No)

If YES,
specify the
name of
prospectiv
e school

S7- Some Grade 7


S8- Some Grade 8

If NO, state
reason for
not
planning to
study next
school year

*TYPES OF DISABILITIES (see DepEd Order No.2, s.2014 for detailed description)
1- Visual impairment
6- Serious emotional disturbance
2- Hearing impairment
7- Autism
3- Intellectual disability
8-Orthopedic impairment
4- Learning disability
9- Special health problems
5- Speech/language impairment
10- Multiple disabilities

C2- Completed Grade 2


C3- Completed Grade 3
C4- Completed Grade 4
C5- Completed Grade 5
C6- Completed Grade 6

C9- Completed Grade 9


C10- Completed Grade 10
C11- Completed Grade 11
C12- Completed Grade 12

S2- Some Grade 2


S3- Some Grade 3
S4- Some Grade 4
S5- Some Grade 5
S6- Some Grade 6

S9- Some Grade 9


S10- Some Grade 10
S11- Some Grade 11
S12- Some Grade 12

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