Data Gathering Instrument
Data Gathering Instrument
Date : ____________________________
Encircle the letter of your choice that best describes you as a learner.
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. Ifugao
background
b. Igorot
c. Ibanag
d. Gaddang
e. Muslim
f. Ibaloy
g. 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
Characteristics of learners
Civil Status: a. Single
b. Married
c. Widow
d. Separated
Previous experience TM Certificates
with the topic a. TQ certified
b. TM graduate
c. TM trainer
d. TM lead trainer
Number of years as a competency trainer ______
Previous learning List down trainings related to TM
experience ___________________________
___________________________
___________________________
Training Level National Certificates acquired and NC level
completed ___________________________
___________________________
Special courses Other courses related to TM
a. Units in education
b. Master’s degree units in education
c. Others (please specify)
_______________________________
Physical ability 1. Disabilities(if any)_____________________
2. Existing Health Conditions (Existing illness if
any)
a. None
b. Asthma
c. Heart disease
d. Anemia
e. Hypertension
f. Diabetes
Others(please specify) ___________________