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Form 1.1 Sample Data Gathering Instrument For Trainee
Form 1.1 Sample Data Gathering Instrument For Trainee
Department of Education
Region VIII-Eastern Visayas
Division of Leyte
Danilo B. Cumpio
SHS Teacher, PNHS
Characteristics of learners
c. College Level
d. College Graduate
e. with units in Master’s degree
f. Masteral Graduate
g. With units in Doctoral Level
h. Doctoral Graduate
Sex a. Male
b. Female
Age Your age: _____
Physical ability 1. Disabilities(if any)_____________________
2. Existing Health Conditions (Existing illness if
any)
a. None
b. Asthma
c. Heart disease
d. Anemia
e. Hypertension
f. Diabetes
g. Others(please specify) ___________________
CHS/CSS Certificates
Previous
experience with a. COC 1 certified
the topic b. COC 2 certified
c. COC 3 certified
d. COC 4 certified
e. CHS NC II holder
Number of years as a computer technician______
List down trainings related to CSS
Previous learning
experience ___________________________
___________________________
___________________________
National Certificates acquired and NC level
Training Level
completed ___________________________
___________________________
Other courses related to CSS
Special courses
a. Units in education
b. Master’s degree units in education
c. Others(please specify)
Danilo B. Cumpio
SHS Teacher, PNHS
Characteristics of learners
_________________________
Danilo B. Cumpio
SHS Teacher, PNHS