Data Gathering Instrument

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 you need your response.

Characteristics of Learners
Average grade in: Average grade in:
English Math
Language, literacy and a. 95 and above a. 95 and above
numeracy (LL&N) 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 language Ethnicity/culture:
background a. Ifugao
b. Igorot
c. Ibanag
d. Bisaya
e. Muslim
f. Ibaloy
g. Tagalog
h. Others(please specify)____________________
Education and general Highest Educational Attainment:
knowledge a. Elementary Graduate
b. High School Level
c. High School Graduate
d. College Level
e. College Graduate
f. With units in Master’s Degree
g. Masteral Graduate
h. With unit in Doctoral Level
i. 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

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Previous experience with the
topic
Previous learning experience
Training Level Completed
Special Courses
Learning Styles
Develop by: MATEO A. ALIN JR.
Data Gathering Instrument
c. Hearth Disease
d. Anemia
e. Hypertension
f. Diabetes
g. Others (please specify)_________________
Basic Food and Beverage Services:
a. Seminars
b. Special Training
c. Industry/Work experience
d. Number of years as a Competency Trainer______
List down trainings related to Food and Beverage Services:
Food and Beverage Services NCII Level
__________________________
__________________________
Other courses related to TM I
a. Units in Education
b. Master’s Degree units in education
c. Others (please specify)
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 issue.
c. Auditory – a learner who has the ability to remember
speeches and lecture 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.
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 Data Gathering Instrument

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.
Other needs a. Financially challenged
b. Working student
c. Solo parent
d. Others (please specify) ________________________

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