Republic of the Philippines

STANDARD SCORE EQUIVALENT OF SUM OF 1st Ass. 2nd Ass. Department of Education
DOMAINS
SCALED SCORE TABLE Raw Scaled Raw Scaled Region IX, Zamboanga City Peninsula
39 51 54 73 69 95 84 117 GROSS MOTOR Division of Zamboanga City
40 53 55 75 70 97 85 119 FINE MOTOR
41 54 56 76 71 98 86 120 SELF-HELP
Manicahan District
42
43
56
57
57
58
78
79
72
73
100
101
87
88
122
123
RECEPTIVE SKILLS
EXPRESSIVE SKILLS
SANGALI ELEMENTARY SCHOOL
44 59 59 81 74 103 89 124 COGNITIIVE KINDERGARTEN DEPARTMENT
45 60 60 82 75 104 90 126 SOCIAL-EMOTIONAL JK
Sangali, Zamboanga City
46 62 61 84 76 105 91 127 RAW AND SCALE SCORES
47
48
63
65
62
63
85
86
77
78
107
108
92
93
129
130
STANDARD SCORE
INTERPRETATION
Philippine Early Childhood Care
49
50
51
66
67
69
64
65
66
88
89
91
79
80
81
110
111
113
94
95
96
132
133
135
DATE TESTED
NAME OF EXAMINER
SIGNATURE
Development Checklist
52 70 67 92 82 114 97 136 PARENT'S COMMENT School Year 2024-2025
53 72 68 94 83 116 98 138 SIGNATURE

Gross Receptive Expressive Social

Fine Motor Self - Help Cognitive
Motor Language Language Emotional STANDARD SCORE
5.1 5.1 5.1 5.1
A
4.1
-
-
4.1
-
-
4.1
-
-
4.1
-
-
4.1
-
5.1- 4.1- 5.1- 4.1- 5.1- INTERPRETATION
G 5.1 5.1 5.1 5.1 5.11 5.0 5.11 5.0 5.11
5.0 5.0 5.0 5.0 5.0
E 1 1 1 1
1 0-5
0-
0-3 0-5
0-
_ 0-1 0-2 - - 0 0-9 0-13 0-15 Score Interpretation
10 15
0-
2 6 _ 4 _ 16 _ - 0-5 - 1 10 14 16
19
130 Suggest highly
3 _ _ _ 6 17 20 2 - - - 2-3 11 15 17
and
above
A advanced
development
4 7 11 5 _ 18 21 _ 3 - - 4 12 16 -

6
8

_
_

_
6

_
7

_
19

20 22
_ _

3
-

-
6

-
0-7

_
5

6-7
13

14
17

_
18

19
120-
B
Suggest slight
advanced
DAVID JHON H.________________
Child’s Name: ____________________________ PEREZ
129 development
Date of Birth: _______________________
7

8 10
9 12

_
7

_
8

9 21
_ 23

_
_

_
-

4
-

7
-

-
8

9-10
15

16
18

19
20

_
MAY 28, 1993 LRN No:
9 _ _ 8 _ 22 24 4 - - - 11 17 20 21 80-119 C Average
development Sex: _____ Age: ___ yrs. old as of _OCTOBER_
M 126170
____________________
10 11 _ 9 10 23 25 _ - - - 12 18 21 22
5 ___
13- Suggest slight
11 12 13 _ _ 24 _ 5 5 8 8 19 22 23

12 _ _ 10 11 25 26 _ - - -
14
15 20 23 _
70-79 D delayed in
overall CHILD’S SOCIODEMOGRAPHIC PROFILE
development
16-
13 13 _ _ _ 26 27 _ - - 21 24 24
17
69-
Suggest Handedness: ( ) Right ( ) Left ( ) Both Child’s Birth Order: ________
14 _ _ 11 _ 27 _ _ - _ _ 18
19-
_ _ _
below E significant
delay in overall Father’s Name: ALDEN RICHARD FAULKERSON JR. Occupation: ___________________
15 _ _ _ _ _ _ _ - _ _ _ _ _ development
20
16 _ _ _ _ _ _ _ - _ _ 21 _ _ _
Mother’s M. Name: KATHRYN MANUEL-BERNARDO Occupation: ___________________
Address: MANICAHAN, ZAMBAOANGA CITY Religion/Dialect: RC / CHAVACANO

CERTIFICATE OF COMPLETION Dear Parents:

DAVID JHON H. PEREZ under

This is to certify that ______________________________________ The Philippines Early Childhood Care Development Checklist contains knowledge, skills and
attitude of a 5-year-old child. This may be used as a guide in knowing your child and consequently
Kinder-_PEREZ has completed the Kindergarten Curriculum as prescribed by the give appropriate care and teaching to guide his/her growth and development
Department of Education School Year 2024-2025.
Approved by:
DAVID JHON H. PEREZ HELEN D. ABAD, EdD
DAVID JHON H. PEREZ HELED D. ABAD, EdD Class Adviser Elem. School Principal IV
Class Adviser Elem. School Principal IV
 4 Names objects in pictures
Demonstrates respect for elders using
1st 2nd 8
I. GROSS MOTOR DOMAIN 9 Drinks from cup unassisted Speaks in grammatically correct 2-3 words terms like “po” and “opo”
5
Climbs on chair or other elevated piece sentences 9 Shares toys with others
1 10 Gets drink for self-unassisted
of furniture like bed or without help 6 Asks “what” questions Imitates adults activities (e.g., cooking,
11 Pours from pitcher without spillage 10
2 Walks backwards watching)
7 Asks “who” and “why” questions 11 Identifies feelings of others
3 Runs without tripping of falling 12 Prepares own food / snack
Walks downstairs, 2 feet on each step, Gives account of recent experiences (with Appropriately uses cultural gestures of
4 Prepares meals for younger siblings/family 8 prompting) in order of occurrence using
with one hand held 13 12 greeting without much prompting (e.g.,
members when no adult is around past tense
Walks upstairs holding handrail, 2 feet mano/bless, kiss, etc.)
5 Participates when being dressed (e.g.,
on each step 14 13 Comforts playmates/siblings in distress
raises arms or lift leg) TOTAL
Walks upstairs with alternative feet Persists when faced with a problem of
6 15 Puts down gartered short pants 14
without holding handrail obstacles of his wants
Walks downstairs with alternate feet 16 Removes sando Helps with family chores (e.g, wiping
7 15
without holding handrail Dresses without assistance except for VI. COGNITIVE DOMAIN 1st 2nd tables, watering plats, etc.)
17
8 Moves body part as directed buttons and tying 1 Look at the direction of fallen objects Curious about environment but knows
9 Jumps up Dresses without assistance including 16 when to stop asking questions to adults
18 Imitate behavior just seen a few minutes
10 Throws ball overhead with direction buttons and tying 2
Informs the adult only after he/she has earlier 17 Wait for his/her turn
11 Hops 1 to 3 steps on preferred foot Offers object but not release it
19 already urinated (peed) or removed his/her 3 Ask permission to play with toy being used
12 Jumps and turns 18
bowels (poohed) in designated area 4 Look for completely hidden object by others
Dances patterns / joins group
13 Informs adult of need to urinate (peed) or 19 Defends possessions with determination
movement activities Exhibits simple pretend play (feed, put doll
moved bowels (poohed) so he/she can be 5 Plays organized group games fairly (e.g.,
20 on sleep) 20
TOTAL brought to a designated place (e.g., does not cheat in order to win)
comfort room) 6 Matches objects
Can talk about difficult feelings (e.g.,
Goes to designated place to urinate (pee) Matches 2 colors 21 anger, sadness, worry) he/she
21 7
or move bowels (pooh) experienced
II. FINE MOTOR DOMAIN 1st 2nd Goes to designated place to urinate (pee) 8 Matches 3 colors
Honors a simple bargain with caregiver
22 or move bowels (pooh) and never does this Matches pictures 22 (e.g, can play outside only after cleaning
Uses all 5 fingers to get food/toys 9
1 in his/her underpants anymore his/her table)
placed on flat surface Sorts based on shapes
Wipes/cleans self after a bowel movement 10 Watches responsibly over younger
Picks up objects with thumb and index 23 23
2 (pooh) Sorts objects based on 2 attributes (e.g., siblings/family members
finger 11
Participates when bathing (e.g., rubbing size and color) Cooperates with adults and peers in group
3 Displays a definite hand preference 24
arms with soap) Arranges objects according to size from 24 situations to minimize quarrels and
12 conflicts
4 Puts small objects in/out of containers 25 Washes and dries hands without any help smallest to biggest
Holds crayon with all the fingers of his 13 Names 4 – 6 colors
5 TOTAL
hand making a fist (i.e., palmer grasp) 26 Washes face without any help
14 Copies shapes
Unscrews lid of container or unwraps 27 Bathes without any help
6 Names 3 animals or vegetables when
food 15
TOTAL asked
7 Scribbles spontaneously States what common household items are Each item observed are recorded twice within a year,
16
8 Scribbles vertical and horizontal lines used for at the start and end of the school year.
IV. RECEPTIVE LANGUAGE DOMAIN 1st 2nd Can assemble simple puzzles
17 Content:
9 Draws circle purposely Points to family member when asked to do
Draws a human figure (head, eyes, 1 Demonstrates an understanding of I. Gross Motor Domain (13 items)
10 so
trunk, arms, hands and fingers) 18 opposites by completing a statement (e.g, II. Fine Motor Domain (11 items)
Points to 5 body parts on himself/herself
2 Angaso ay malaki, angdaga ay _________) III. Self-Help Domain (27 items)
11 Draws a house using geometric forms when asked to do so
19 Points to the left and right sides of the body IV. Receptive Language Domain (5 items)
Points to 5 named pictured objects when V. Expressive Language Domain (8 items)
3
TOTAL ask to do so Can state what is silly or wrong with VI. Cognitive Domain (21 items)
20
Follows one-step instructions that include pictures (e.g., Anoangmalisalarawangito?) VII. Social-Emotional Domain (24 items)
4 simple prepositions (e.g., in, on, under,
21 Matches upper and lower case letters Scores: ( √ ) Present or child is able to do the task
III. SELF-HELP DOMAIN 1st 2nd etc.)
Follows two0step instructions that include ( --- ) Skill is not present or child does not respond
Feeds self with finger food (e.g., 5 TOTAL
1 simple prepositions
biscuits, bread) using fingers
TOTAL Legend for comments per skills if not present or
2 Feeds self using spoon does not respond
3 Feeds self using fork VII. SOCIAL – EMOTIONAL DOMAIN 1st 2nd NA Item Not Applicable
4 Feeds self using fingers Enjoys watching activities of nearby people LO Lack of Opportunity
1
V. EXPRESSIVE LANGUAGE DOMAIN 1st 2nd or animals ND Response was Not Displayed 2 and 3 Trials
5 Feeds self using spoon without spillage Friendly with strangers but initially may
1 Uses 5-20 recognizable words 2
Eats without need for spoon feeding show slight anxiety or shyness
6 2 Uses pronouns (e.g., I, me, ako) Plays alone but likes to be near familiar
during any meal 3 LEGEND OF SKILLS
adults or brothers and sisters
7 Helps hold cup for drinking Uses 2-3 words verb-noun combinations Skills of Ages 4.1 to 5.0 years old
3 4 Laughs or squeals aloud in play
(e.g., hingi, gatas)
8 Drinks from cup without spillage Skills of Ages 5.1 to 5.11 years old
5 Plays peek-a-boo (bulaga)
Skills of Ages 4.1 to 5.11 years old
Rolls ball interactively with
6
caregiver/examiner