SAMPLE DATA GATHERING ISNTRUMENT FOR TRAINEES CHAARACTERISTICS

Name: ELIZALDE P. BARROSA

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
a. 75 to 79 e. 75 to 79

Cultural and Ethnicity/culture:

language a. Bicol Naga
background
b. Bicol Rinconada
c. Bicol Legazpi
d. Bicol Partido
e. Others( please specify)____________

Education & Highest Educational Attainment:

general knowledge a. High School Level
b. High School Graduate
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: 48

Physical ability 1. Disabilities(if any)_____________________

 Characteristics of learners

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) ___________________
None Certificates
Previous
experience with  _________
the topic  _________

Number of years as a competency trainer ______

List down trainings related to ______
Previous learning
experience __________None_________________
__________None_________________
___________________________
National Certificates acquired and NC level
Training Level
completed _________None_____________
___________________________
Other courses related to ________
Special courses
a. _None__
b. ________
c. 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.
 Characteristics of learners

d. Activist - Learns by having a go

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) ___________________________