Valenzuela City Technological College

Kamagong St., Fortune VI, Parada, Valenzuela City

Form 1: Data Gathering Instrument for Learner's Characteristics

Name: Rayza D. Austria_______________________________________

Date: _____________
Qualification:Carpentry Age: 21_____________

Instruction:
Please answer the following tool according to the characteristics that best describe you as a
learner. Encircle the letter of your choice or use provided blank spaces to write your response.

Language, literacy, and numeracy (LL&N)

Reading Comprehension Writing Skills Solving Math Problems Computer Literacy
a. 95 and above a. 95 and above
b. 90 to 94 a. 95 and above b. 90 to 94 a. 95 and above
c. 85 to 89 b. 90 to 94 c. 85 to 89 b. 90 to 94
d. 80 to 84 c. 85 to 89 d. 80 to 84 c. 85 to 89
e. 75 to 79 d. 80 to 84 e. 75 to 79 d. 80 to 84
e. 75 to 79 e. 75 to 79

Cultural and language Ethnic group: Language Spoken:

background a. Tagalog Please specify:
b. Cebuano __________________
c. Ilocano __________________
d. Hiligaynon __________________
e. Bicolano __________________
f. Waray
g. Moro Tribal group: if any
h. Others: please specify __________________
________________
Education & general Highest Educational Attainment:
knowledge a. High School Level
b. High School Graduate
c. College Level
d. College Graduate
e. with units in Master's degree
f. Masters Graduate
g. With units in Doctor's degree
h. Doctoral Graduate
Sex a. Male b. Female
Physical ability I. Disabilities(if any)_____________________
II. Existing Health Conditions (Existing illness if any)
a. None
b. Asthma
c. Heart disease
d. Anemia
e. Hypertension
f. Diabetes
g. Others(please specify) __________________
 Valenzuela City Technological College
Kamagong St., Fortune VI, Parada, Valenzuela City

Previous experience with Training Related Experiences to your Qualification

the program a. N/A_______________________
b. _______________________
c. _______________________

Number of years in the job related to your

Qualification______
Previous learning List down trainings related to your Qualification
experience a. N/A____________________________________
b. ____________________________________
c. ____________________________________

National Certificates National Certificates acquired and NC level

a. N/A____________________________________
b. ____________________________________
c. ____________________________________
Special courses Other courses related to your Qualification
a. N/A____________________________________
b. ____________________________________
c. ____________________________________
Learning style 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.
Other needs a. Financially challenged
b. Working student
c. Solo parent
d. Others(please specify) _________________________