PARENTS/GUARDIAN SIGNATURE

Prelim Midterm Final

________________________________ ________________________________ ________________________________

Months Number of School Days Number of Days Present Number of Times Tardy

Ju n

Jul

Au g

Se p

Oc t

No v

De c

Ja n

Fe b

M ar

Tot al

ACTION TAKEN Promoted to _________________________________ Retained in _________________________________ Eligible for transfer/admission to _____________ Date ________________________________________

Form 2
(3.1 years 5.11 years)

_________________________ Childs Name

_____________________ Teacher _______________________ Principal
1 Climbs on chair or GROSS MOTOR DOMAIN P O R Comm P O R Comm ent ent

P O R Comm ent

2 3 4 5 6 7 8 9 1 0 1 1 1 2 1 3

other elevated piece of furniture like bed without help Walks backwards Runs without tripping or falling Walks downstairs, 2 feet on each step, with one held Walks upstairs with holding handrail, 2 feet on each step Walks upstairs with alternate feet without holding handrail Walks downstairs with alternate feet without holding handrail Moves body parts as directed Jumps up Throws ball overhead with direction Hops 1 to 3 steps on preferred foot Jumps and turns Dance patterns/joins group movement activities TOTAL

6 7 8

1 5

in/out of containers Holds crayon with all the fingers of his hand making a fist (i.e., palmar grasp) Unscrews lid of container or unwraps food Scribbles spontaneously Scribbles vertical and horizontal lines SOCIAL-EMOTIONAL DOMAIN P O R Comm P O R Comm ent ent Helps with family chores (e.g. wiping
tables, watering plants, etc.)

P O R Comm ent

1 6 1 7 1 8 1 9 2 0 P O R Comm ent 2 1

Curios about environment but knows when to stop asking questions of adults Waits for his turn Asks permission to play with toy being used by another Defends possessions with determination Plays organized group games fairly (e.g. does not cheat in order to win) Can talk about difficult feelings (e.g. anger, sadness, worry) he experience Honors a simple bargain with caregiver (e.g. can play outside only after cleaning/finishing his room)

FINE MOTOR DOMAIN P O R Comm P O R Comm ent ent 1 2 3 4 Uses all fingers to get food/toys placed on flat surface Picks up objects with thumbs and index finger Displays a definite hand preference Puts small objects

2 2

23

Watches responsibly over younger

siblings/family

2 1

2 4

members Cooperate with adults and peers in group situation to minimize quarrels and conflicts TOTAL 1

Matches upper and lower case letters TOTAL

SOCIAL-EMOTIONAL DOMAIN P O R Comm P O R Comm ent ent Enjoys watching activities of nearby people or animals Friendly with strangers but initially may show slight anxiety or shyness Plays alone but like to be near familiar adults or brothers and sisters Laughs or squeals aloud in play Plays peer-a-boo (bulaga) Rolls ball interactively with caregiver/examiner Hugs or cuddles toys Demonstrates respect for elders using terms po at opo Shares toys with others Imitates adult activities (e.g. cooking, washing) Identifies feelings in others Appropriately uses cultural gestures of greeting without much prompting (e.g. mano, bless, kiss, etc.) Comforts playmates/siblings in distress Persists when faced

P O R Comm ent

SUMMARY FOR EACH DOMAIN

DOMAINS PRE-LIM SCORE GROSS MOTOR FINE MOTOR SELF-HELP RECEPTIVE LANGUAGE EXPRESSIVE LANGUAGE COGNITIVE SOCIAL-EMOTIONAL COGNITIVE DOMAIN P O R Comm P O R Comm ent ent Demonstrate an understanding of opposites by completing statement (e.g. Ang aso ay malaki, ang daga ay _______) Points to left and right side of the body Can state what is silly or wrong with pictures (e.g. Ano ang mali sa larawang ito?) P O R Comm ent SCALE D SCORE MID-TERM SCORE SCALE D SCORE FINAL

3 SCORE SCALE D SCORE 4 5 6 7 8 9 1 0 1 1 1 2 1 3 1

1 8

1 9 2 0

with problem or obstacle to his wants FINE MOTOR DOMAIN P O R Comm P O R Comm ent ent P O R Comm ent

2 3 4 5 6 7

9 1 0 1 1

Draws circles purposely Draws a human figure (head, eyes, trunk, arms,hands/fingers Draws a house using geometric forms TOTAL

RECEPTIVE LANGUAGE DOMAIN P O R Comm P O R Comm ent ent 1 2 3 Points to family member when asked to do so Points to 5 body parts on himself when asked to do so Points 5 named pictured objects when asked to do so Follows one-step instruction that include simple prepositions (e.g. in, on, under, etc.) Follows two-step instruction that include simple prepositions TOTAL

P O R Comm ent

recognizable words Uses pronouns (e.g. I, me, ako, akin) Uses 2-3 words verbnoun combination (e.g. hingi gatas) Names objects in pictures Speaks in grammatically correct 2-3 sentences Asks what questions Asks who and why questions Gives account of recent experience (with prompting) in order of occurrence using past tense TOTAL SELF-HELP DOMAIN P O R Comm P O R Comm ent ent P O R Comm ent

1 2 3 4 5 6 7

EXPRESSIVE LANGUAGE DOMAIN P O R Comm P O R Comm ent ent 1 Uses 5-20

P O R Comm ent

8 9

Feeds self with finger food (e.g.biscuits, bread) using fingers Feeds self using spoon with spillage Feeds self using spoon without spillage Feeds self using fingers with spillage Feeds self using fingers without spillage Eats without need for spoon feeding during any meal Helps hold cup for drinking Drinks from cup with spillage Drinks from cup unassisted

1 0 1 1 1 2 1 3 1 4 1 5 1 6 1 7 1 8

Gets drink for self unassisted Pours from pitcher without spillage Prepares own foods/snacks Prepares meals for younger siblings/family members when no adult is around Participates when being dressed (e.g.
raises arms of lift legs)

P O R Comm ent 2 2 Goes to the designated place to urinate (pee) or move bowels (pooh) but sometimes still does this in his underpants Wipes/cleans self after a bowel movement (pooh) Participates when bathing (e.g. rubbing arms with soap) Washes and dries hands without any help Washes face without any help Bathes without any help TOTAL

P O R Comm ent

P O R Comm ent

2 3 2 4 2 5 2 6 2 7

Pulls down gartered short pants Removes sando Dresses without assistance except for buttons and tying Dresses without assistance including buttons and tying Informs the adult only after he has already urinated(peed) or moved his bowels(poohed) in his underpants Informs adult of need to urinate (pee) or move bowels (poohpooh) but sometimes still does this in his underpants Goes to the designated place to urinated (pee) or move bowels (poohpooh) so he can brought to a designated place (comfort room) SELF HELP DOMAIN

1 9

COGNITIVE DOMAIN P O R Comm P O R Comm ent ent 1 2 3 4 5 6 7 8 9 Offers object but completely hidden object Looks for completely hidden object Exhibits simple pretend play (feed, put doll to sleep) Matches object Matches 2-3 colors Matches pictures Looks at direction of fallen object Imitates behavior just seen a few minutes earlier

P O R Comm ent

2 0

2 1

1 0 1 1 1 2 1 3 1 4 1 5 1 6 1 7

Sort objects based on shapes Sorts objects based on 2 attributes (e.g. size and color) Arrange objects according to size from smallest to biggest Names 4-6 colors Copies shapes Names 3 animals or vegetables when asked States what common household items are used for Can assemble simple puzzles