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Last

First
ANNEX IB Child Mapping Tool

NAME

Middle
Name of Barangay: _____________________________
Division: ______________________________________

Gender

Relatonship to the
Household Head

Is Resident Permanent
(Y/N)

Home Address

Number of Years in
said Address
If YES, indicate

Age

Date of Birth

With Birth Certfcate


(Y/N)

Ethnicity
TOOL MAPPING FOR 11-17 YR. OLD STUDENTS

Religion

if Disability, specifc
type

Provided with ECCD


Services

If YES, specify ECCD


Facility
If 11-12 years old…

Highest Educatonal
Level Completed
ASK:"Is the child a permanent resident?" (YES/NO) If yes, follow up "do the residents plan on moving up?"
TYPES OF DISABILITIES: EDUCATIONAL ATTAINMENT:
1-Visua; Impairment 6-Serious Emotonal Disturbance CK-Completed Kindergarten SK-Some Kindergarten
2-Hearing Impairment 7-Autsm C1-Completed Grade 1 C7-Completed Grade 7 S1-Some Grade 1
3-Intellectual Disability 8-Orthopedic Impairment C2-Completed Grade 2 C8-Completed Grade 8 S2-Some Grade 2
4-Learning Disability 9-Special Health Problem C3-Completed Grade 3 C9-Completed Grade 9 S3-Some Grade 3
5-Speech/Language Impairment 10-Multple Disabilites C4-Completed Grade 4 C10-Completed Grade 10 S4-Some Grade 4
C5-Completed Grade 5 C11-Completed Grade 11 S5-Some Grade 5
C6-Completed Grade 6 C12-Completed Grade 12 S6-Some Grade 6
Last
First
NAME

Middle
Gender
Age
Birth
Date of
DEMOGRPHIC INFORMATION

Birth
With

e (Y/N)
Certfcat

Present Address

Is Resident
Permanent (Y/N)
RESIDENCE

Number of Years in
said Address

Has a Disability (Y/N)

If YES, specify the


DISABILITY

type of disability

Provided with ECCD


Services?(Y/N)
Student)

If YES, specify ECCD


Services
ECCD (for 12YO

Educatonal
Atainment

Currently Studying?
(Y/N)
EDUCATIONAL
ASK:"Is the child a permanent resident?" (YES/NO) If yes, follow up "do the residents plan on moving up?"
TYPES OF DISABILITIES: EDUCATIONAL ATTAINMENT:
1-Visua; Impairment 6-Serious Emotonal Disturbance CK-Completed Kindergarten SK-Some Kindergarten
2-Hearing Impairment 7-Autsm C1-Completed Grade 1 C7-Completed Grade 7 S1-Some Grade 1
3-Intellectual Disability 8-Orthopedic Impairment C2-Completed Grade 2 C8-Completed Grade 8 S2-Some Grade 2
4-Learning Disability 9-Special Health Problem C3-Completed Grade 3 C9-Completed Grade 9 S3-Some Grade 3
5-Speech/Language Impairment 10-Multple Disabilites C4-Completed Grade 4 C10-Completed Grade 10 S4-Some Grade 4
C5-Completed Grade 5 C11-Completed Grade 11 S5-Some Grade 5
C6-Completed Grade 6 C12-Completed Grade 12 S6-Some Grade 6
Municipality: ________________________
Region: _____________________________

11-17 YR. OLD STUDENTS


If YES,

Is Currently studying?

If thru ADM, specify


If NO,

Name of School

type of ADM
state

What Level
(Y/N)
reason
for not
studying
S7-Some Grade 7
S8-Some Grade 8
S9-Some Grade 9
S10-Some Grade 10
S11-Some Grade 11
S12-Some Grade 12
If YES, specify Name
of School

If NO, reason for not


studying
EDUCATIONAL STATUS

If studying thru
ADM, specify type of
ADM

Planning to study
next school year?
(Y/N)

If YES, specify the


name of prospectve
school

If NO, state reason


for not planning to
study next school
year
S7-Some Grade 7
S8-Some Grade 8
S9-Some Grade 9
S10-Some Grade 10
S11-Some Grade 11
S12-Some Grade 12

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