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Tool For Mapping Of12-30 Yr. Old Children

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Baranggay: __________________________________________________________________________ Division: ______________________________

Municipality: _________________________________________________________________________ Region: ______________________________

TOOL FOR MAPPING OF12-30 YR. OLD CHILDREN

DEMOGRAPHIC
NAME INFORMATION RESIDENCE DISABILITY EDUCATIONAL STATUS FUTURE ENROLMENT
If Yes,
Is INTERVIEWER NAME AND SIGNATURE
Planning specify
resid Currentl If studying If No, state
With Number If Yes, If Yes, to study the
G ence Education y If No, state through reason for not
Birth of Years Has a specify specify next
DATE OF INTERVIEWSname
e A Present per al studyin reason for ADM,speci planning to
Date of Certific in Disabil types name of school of
Last Middle n g Address man Attainment g Yes/ not studying fy type of study next
First Birth ate? present ity? of School Year? prospe
d e ent? No ADM school year
Yes/N address disabili (Yes/ No) ctive
e Yes/
o ty school
r No
CASE: “Is the child a permanent resident? (YES/NO) , If YES, follow-up “Do the residents plan on moving out?”

TYPES OF DISABILITIES: (PER DepED Order No. 2, s.2014 for detailed descriptions)

1. Visual Impairment 6. Serious Emotional Disturbance


2. Hearing Impairment 7. Autism
3. Intellectual Disability 8. Orthopedic Impairment
4. Learning Disability 9. Special Health Problems ____________________
5. Speech/ Language Impairment 10. Multiple Disabilities

EDUCATIONAL ATTAINMENT:

CK- Completed Kindergarten SK- Some KIndergarten


C1- Completed Grade 1 S1- Some Grade 1
C2- Completed Grade 2 S2- Some Grade 2
C3- Completed Grade 3 S3- Some Grade 3
C4- Completed Grade 4 S4- Some Grade 4
C5- Completed Grade 5 S5- Some Grade 5
C6- Completed Grade 6 S6- Some Grade 6
C7- Completed Grade 7 S7- Some Grade 7
C8- Completed Grade 8 S8- Some Grade 8
C9- Completed Grade 9 S9- Some Grade 9
C10- Completed Grade 10 S10- Some Grade 10
C11- Completed Grade 11 S11- Some Grade 11
C12- Completed Grade 12 S12- Some Grade 12
Makiling National High School

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