NAME: _____________________________ DATE: _____________
QUALIFICATION: __________________
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 need your response.
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
a. 75 to 79 e. 75 to 79
Cultural and Ethnicity/culture:
language a. Mangyan
background
b. Tagalog
c. Muslim
d. Others( please specify)_____________
Education & Highest Educational Attainment:
general a. High School Level
knowledge
b. High School Graduate
c. Senior High School Level
d. Senior High School Graduate
e. College Level
f. College Graduate
g. with units in Master’s degree
h. Masteral Graduate
i. With units in Doctoral Level
j. Doctoral Graduate
Sex a. Male
Characteristics of learners
b. Female
Age Your age: _____
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
g. Others(please specify) ___________________
CSS Certificates
Previous
experience with a. CSS certified
the topic b. CSS graduate
c. CSS trainer
d. CSS lead trainer
Number of years as a competency trainer ______
List down trainings related to CSS
Previous
learning ___________________________
experience ___________________________
___________________________
National Certificates acquired and NC level
Training Level
completed ___________________________
___________________________
Other courses related to CSS
Special courses
a. Units in education
b. Master’s degree units in education
c. Others(please specify)
_________________________
Learning styles 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
Characteristics of learners
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.
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.
a. Financially challenged
Other needs
b. Working student
c. Solo parent
d. Others(please specify)
___________________________
