Summary Report On Early Childhood Development Checklist ECCD For Kindergarten Blank Form

Department of Education Region: ______________________________________ Division: _____________________________________ City/Municipality: _______________________________

District: __________________________________________ Barangay: ________________________________________ School: ___________________________________________

Sex

Raw Score

Scaled Score

Raw Score

Submitted by: _____________________________________ Name of Teacher

Scaled Score

Self-help Domain Raw Score

Scaled Score

Receptive Domain Raw Score

Scaled Score

Expressive Domain Raw Score

Scaled Score

Cognitive Domain Raw Score

Scaled Score

Social Emotional Domain Raw Score

Scaled Score

NOTED: _____________________________________ School Head

Not Ready

Age

Fine Motor

Ready

Name of Pupils

Gross Motor

Remarks Day-Care

No. of Items which the child failed to exhibit/perform per domain

Sum of Scaled Score Standard Score

SUMMARY REPORT ON EARLY CHILDHOOD DEVELOPMENT CHECKLIST ECCD FOR KINDERGARTEN