This document is a general intake sheet for children served by an early childhood care and development facility in the Philippines. It collects information such as the location of the facility, demographic details of the children served including age, gender and disability status. Fields are included to track the total number of children served, children with disabilities, those provided other services, indigenous peoples children and Muslim children. The sheet is to be completed by an individual and signed by the day care supervisor, including an encode ID number.
This document is a general intake sheet for children served by an early childhood care and development facility in the Philippines. It collects information such as the location of the facility, demographic details of the children served including age, gender and disability status. Fields are included to track the total number of children served, children with disabilities, those provided other services, indigenous peoples children and Muslim children. The sheet is to be completed by an individual and signed by the day care supervisor, including an encode ID number.
This document is a general intake sheet for children served by an early childhood care and development facility in the Philippines. It collects information such as the location of the facility, demographic details of the children served including age, gender and disability status. Fields are included to track the total number of children served, children with disabilities, those provided other services, indigenous peoples children and Muslim children. The sheet is to be completed by an individual and signed by the day care supervisor, including an encode ID number.
This document is a general intake sheet for children served by an early childhood care and development facility in the Philippines. It collects information such as the location of the facility, demographic details of the children served including age, gender and disability status. Fields are included to track the total number of children served, children with disabilities, those provided other services, indigenous peoples children and Muslim children. The sheet is to be completed by an individual and signed by the day care supervisor, including an encode ID number.
Republic of the Philippines ECCDSID to be filled up by the encoded
Department of Social Welfare and Development Children Served Profile Early Childhood Care and Development
I. Children Facility LocationNOTE: Fields with (*) asterisk are required fields
Region District/Province Municipality Barangay Name of Facility
II. Children Served 2. Children w/ Disability 3. Children Provided with Other Services 4. Indigenous People’s 5. Muslim 6. Total Children Children Served Children Served Dropped Out 1a. Age 1b. Gender Total 2b. Physical 2c. Mental Group Served OH VI H Other UT/EMR WA IMP WADHD SL W D SF MNS D Others I G W S 3 yrs. Male old Female 4 yrs. Male Old Female 5 yrs. Male old Female 6 yrs. Male old Female 7 yrs. Male old Female 8 yrs. Male old Female 9 yrs. Male old Female 10 yrs. Male old Female Children with Disability Keys Children Provided with Services Keys
OH – Orthopedically Handicapped WG – Weigned 7a. Accomplished by: 7b. Date Accomplished*
VI – Visually Impaired DW – Dewormed ______________________________ HI – Hearing Impaired SF – Provided with Supplemental Feeding Other – Other Handicap – Speech Defect MNS – Provided with Micro Nutrient Supplementation YYY – MM - DD Hunchback,Cleft Palate – Harelip DS – Provided with Dental Services UT/EMR – Upper Trainable/Educable Mentally Retarded Other – Other Services 7b. Name and Signature of Day Care Supervisor* 7C. Encode ID* IMP – Improved Mental Patient WA – With Autism WADHD – With attention Deficit Hyperactive Disorder SL – Slow Learners