Data Gathering Instrument for Trainee’s Characteristics
Name: ________________________________
Please answer the following instrument according to the characteristics
described below. Encircle the letter of your choice that best describes you as a
learner. Blank spaces are provided for some data that need your response.
Characteristics of Learners
Language, literacy Average grade in: Average grade in:
and numeracy (LL&N) English Math
a. 95 and above a. 95 and above
b. 90 to 94 b. 90 to 94
c. 85 to 89 c. 85 to 89
d. 80 to 84 d. 80 to 84
e. 75 to 79 e. 75 to 79
Cultural and Ethnicity/culture:
language backgrounda. Ilocano
b. Cebuano
c. Tagalog
d. Ilonggo
e. Muslim
f. Others please specify)
Education & general Highest Educational Attainment:
knowledge a. High School Level
b. High School Graduate
c. College Level
d. College Graduate
e.
Sex a. Male
b. Female
Age
Your age:
Physical ability
a. Existing Health Condition
Asthma
Heart disease
Anemia
Hypertension
Diabetes
Others (please specify) ___________
Previous Work Work Duration
experience related to a. none
Characteristics of Learners
the Housekeeping b. 1 year
NCII c. 1 year - more
d. 2 year-more
Previous learning List down trainings/seminar
experience a.
b.
Learning style Please refer to the previous learning style assessment
a. Visual
b. Auditory
c. Kinesthetic
Other needs a. Financially challenged
b. Working student
c. Solo parent
d. Others (please specify) __________________