Republic of the Philippines

Department of Education
Region V Bicol
Division of Catanduanes

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Philippine Early Childhood

Development Checklist (FORM 2)
AGES 3 YEARS 1 MONTH TO 5 YEARS 11 MONTHS
SCHOOL YEAR 2015 2016
CHILDS NAME:
HANDEDNESS:
BOTH
SEX:

MALE

FEMALE

LRN:

Jennylyn Broola

LEFT

RIGHT

UNESTABLISHED
BIRTH DATE:
10/27/2009

AGE:

174006150011
GRADE LEVEL:
KINDERGARTEN
5 Years, 7

Months, 6 Days

AS OF:
6/2/2015

CHILDS
ADDRESS:
CHILDS

FATHERS

FATHER:

AGE:

EDUCATIONAL

CIVIL

ATTAINMENT:

STATUS:

OCCUPATION:

CUSTODIAL
PARENT:

CHILDS

MOTHERS

MOTHER:

AGE:

EDUCATIONAL

CIVIL

ATTAINMENT:

STATUS:

YES /
NO

CUSTODIAL

OCCUPATION:

YES

PARENT:

AGE OF MOTHER WHEN

BIRTH ORDER (CHILD):

SHE HAD THE CHILD:

ND

RD

NO

ST

OTHERS: ___

GUARDIAN (IF

RELATIONSHIP:

APPLICABLE):

__________________

TO THE PARENTS:
The Philippine Early Childhood Development Checklist (Form 2) contains
knowledge, skills and attitudes of children 3 5.11 years old. This may be
used as a guide in knowing your child and consequently give appropriate care
and teaching to guide their growth and development.

CONTENT:
Every page contains different domains of development with their
corresponding total scores:
- Gross Motor Domain has - Fine Motor Domain has
- Self-help Domain
13 items
11 items
has 27 items
- Receptive Language
- Expressive Language
- Cognitive Domain
Domain has 5 items
Domain has 8 items
has 21 items
- Social-Emotional Domain
has 24 items
Each item observed are recorded three times within a year:
(1) at the start of the year, (2) at the middle of the year, and (3) at the end of
the year.
COLUMNS
P Present or the child can do the
O Observed or the child was
R Report given by the
-

Merly M. Somido

ADVISER

M
M
M

SCORE
Present or child
is able to do
Skill is not present or child
0 no opportunity to observe the
-

Arlene G. Domingo

SCHOOL PRINCIPAL I