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E N G L I S H: Parents' Name Date of Birth Place of Birth Educationa L Attainmen T Religio N Occupatio N Fathe R Moth Er
E N G L I S H: Parents' Name Date of Birth Place of Birth Educationa L Attainmen T Religio N Occupatio N Fathe R Moth Er
E N G L I S H: Parents' Name Date of Birth Place of Birth Educationa L Attainmen T Religio N Occupatio N Fathe R Moth Er
Nickname :
(Last Name)
(First Name)
(Middle Name)
Date of Birth:
Place of Birth:
Address:
Date of
Birth
Parents Name
Educationa
l
Attainmen
t
Place of
Birth
Religio
n
Occupatio
n
Fathe
r
Moth
er
Brothers/Sisters according to the position in the family. (Exclude married members).
1. _________________________ 3.___________________________ 5. ____________________________
Indicate any
Physical disability
___________________
Height
Weight
Nutritional
Health
Legend:
Nutritional Level
O
Obese
O
Over Weight
N
Normal
W
Wasted
SW Severely
Health Condition
E
VS
G
F
P
Excellent
Very
Good
Fair
Poor
RESU
E
N
G
L
I
S
H
Types of
Miscues
Types of
Miscues
Major
Miscue
Post-Test ______________
Self
Correcte
d
Miscue
# of
Miscue
Major
Self
Miscue Corrected
Frustration
Instructional
Independent
NonPre-Test _______________
Miscue
# of
Miscue
Major
Miscue
Frustration
Instructional
Independent
NonPost-Test ______________
Self
Correcte
d
Miscue
# of
Miscue
Major
Self
Miscue Corrected
Mispronunciation
Substitution
Insertion
Omission
Reversal
Repetition
Refusal to
Pronounce
Total
Reading Level
AUDITORY TEST
RIGHT
LEFT
Miscue
# of
Miscue
Mispronunciation
Substitution
Insertion
Omission
Reversal
Repetition
Refusal to
Pronounce
Total
Reading Level
F
I
L
I
P
I
N
O
Pre-Test _______________
Frustration
Instructional
Frustration
Instructional
RESULT
ENGLISH
DENTAL RECORD
TEETH
NORMA
W/
L
DEFECT
S
Pre-Test
REMARK
S
Spe
ed
Readi
ng
Time
Comprehensi
on Level
FILIPINO
Post-Test
Spee
d
Level
Spee
d
Readi
ng
Time
Pre-Test
Spee
d
Level
Comprehensio
n Level
Spe
ed
Readi
ng
Time
Comprehensi
on Level
Post-Test
Spee
d
Level
Spee
d
Readi
ng
Time
Comprehensio
n Level
(Guidance Form 3)
DATE
GRADE &
SECTION
PLACE
OBSERVER
INCIDENT/REPORT
Spee
d
Level