Sample Data Gathering Instrument for Trainee’s

Characteristics
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 English Math
(LL&N)
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 a. Tagalog
background
b. Bisaya
c. Maguindanaon
d. Marananao
e. Others( please specify)_____________

Education & Highest Educational Attainment:

general a. High School Graduate
knowledge
b. College Level
c. College Graduate
d. with units in Master’s degree
e. Masteral Graduate
f. With units in Doctoral Level
g. 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
 Characteristics of learners
e. Hypertension
f. Diabetes
g. Others(please specify) ___________________
CSS Certificate
Previous
experience with a. IT Graduate
the topic b. Data Encoder
c. PC Operation Trainer
d. Programmer
Number of years in service __________
List down trainings related to CSS NCII
Previous
learning ___________________________
experience ___________________________
___________________________
National Certificates acquired and NC level
Training Level
completed ___________________________
___________________________
Other courses related to CSS NCII
Special courses
a. Bachelor of Science in Information
Technology
b. Bachelor of Science in Computer Science
c. Master’s Degree Units in Information
Technology
d. Others(please specify)
_________________________
Learning styles a. Visual - The visual learner takes mental
pictures of information given, so in order for
this kind of learner to retain information,
oral or written, presentations of new
information must contain diagrams and
drawings, preferably in color. The visual
learner can't concentrate with a lot of activity
around him and will focus better and learn
faster in a quiet study environment.
b. Kinesthetic - described as the students in
the classroom, who have problems sitting
still and who often bounce their legs while
tapping their fingers on the desks. They are
often referred to as hyperactive students
with concentration issues.
c. Auditory- a learner who has the ability to
remember speeches and lectures in detail
but has a hard time with written text. Having
to read long texts is pointless and will not be
retained by the auditory learner unless it is
read aloud.
d. Activist - Learns by having a go
 Characteristics of learners

e. Reflector - Learns most from activities where

they can watch, listen and then review what
has happened.
f. Theorist - Learns most when ideas are linked
to existing theories and concepts.
g. Pragmatist - Learns most from learning
activities that are directly relevant to their
situation.
a. Financially challenged
Other needs
b. Working student
c. Solo parent
d. Others(please specify)
___________________________