Form A : LEARNER'S PROFILE

Learner's Code:

Date of Assessment (Month/Day/Year):

Date of Bitht (Month/Day/Year):

Order of Birth (1st, 2nd, etc.):

Mother Tongue:

Tagalog
Iloko
Cebuano
Tausug

Form C: MFAT Tool

Learner’s Code
DIRECTIONS: Check (/) YES if the learner performed the task, or the item indicated was observed. If not, check

Time Started:

Activity 1 Title: LET’S

ITEM CODE ASSESSMENT ACTIVITY
Time Started:
COM-AU-1 Hello, good morning/good afternoon!

Note: The teacher drops a bunch of keys on the floor to produce sounds.

1. Turns head to source when sound is heard

COM-EL-2 Note: First, the teacher introduces her/himself.
What is your name?

2. Tells one’s name / identifies oneself

COM-AU-3 Note: The teacher taps the table.

Do you hear the tapping sound on the table?

3. Responds to questions or nods head appropriately when spoken to

COM-AU-4 Repeat it.

4. Repeats table tapping patterns correctly

COM-RL-5 Do the following:

Stand;
Turn around; Sit down.

5. Recognizes two to three word instructions

COM-RL-6 Note: Observed in item 5

6. Responds to two-word combination

COM-EL-7 Who are the members of your family? What are their names?

7. Calls family members by name

COM-EL-8 Tell me about your family.

8. Tells stories to peers/class and teacher coherently

COM-EL-9 Answer the following questions:

a. What do you do before going to school?
b. What are the things you see in school?
c. Who are in school?
d. What do you do in school?
COM-RL-10 Note: The teacher gets three (3) objects from the box one at a time.
9. Answers
(ball, pencilwh-
andquestions
book)

What is this?

COM-EL-11 10. Identifies

Describe familiar
it. (ball, pencil objects when presented
and book)

11. Describes simple and familiar objects

COM-RL-12 Note: Place the letters and number cards on the table.
(a, b, w, r, s, t,1,2,3,4,5)

Pick up the letters.

COM-SP-13 What is the up

12. Picks sound
theofletters.
a motorcycle?

13. Makes random non-speech sounds (e.g. wooh, wooh, etc.)

COM-RL-14 Note: The teacher reads the words and let the child answer the following
questions:

Identify the initial sound of the words: ask, act and ant. Identify the
medial sound of the words: pat, mat and bat. Identify the final sound of
COM-EL-15 the words:
Repeat what Ana,
I will say,
Aga “My
andTeacher,
Eva. My Hero”.

Indicator: Repeats the

14. Discriminates words/phrases
initial, medial and final sounds

15. Imitates words/phrases and/or local TV/radio commercial

COM-RL-16 Note: Let the child read the words.

Read the following words: is, are, has, for, give and his.

16. Recognizes pre-primer and primer sight words

COM-EL-17 Recite/sing any nursery rhyme that you know.

17. Recites common nursery rhymes

COM-SP-18 Note: To be observed during the conversation

18. Prefers talking rather than using gestures and physical

communication
COM-EL-19 Note: To be observed during the conversation

19. Answers in complete sentence when asked

COM-EL-20 Note: To be observed during the conversation

20. Expresses thoughts or ideas correctly

COM-SP-21 Note: To be observed during the conversation

21. Speaks in an articulated manner in (e.g. without stuttering)

COM-VO- 22 Note: To be observed during the conversation

22. Controls volume of voice when in conversation

COM-VO- 23 Note: To be observed during the conversation

23. Speaks with voice quality when in conversation (e.g. pitch)

COM-VO- 24 Note: To be observed during the conversation

24. Speaks with uninterrupted flow of sounds, words, syllables, and

phrases

COM-EL-25 Do you feel tired? hungry? thirsty? need to go to the

toilet? What do you want to do?

25. Expresses basic needs and/or wants (verbal, gestural, sign)

Time Ended:

Directions: For Observation Checklist check (/) YES if observed and NO if not. Write in the ‘Remark

ITEM CODE OBSERVATION CHECKLIST

CM-34 1. Does the learner have difficulty expressing needs orally?

H-6 2. Does the learner have difficulty listening when spoken to?

H-19 3. Does the learner have difficulty recognizing commands?

H-25 4. Does the learner turns or tilts head to use one eye only in performing
tasks?

Activity 2 Title: TREASU

ITEM CODE ASSESSMENT ACTIVITY
Time Started:
COG NU-26 Note: Teacher gets 3 objects from the treasure box and places them on
the table.

From your left, which object is in the middle? last? first?

26. Recognizes position of objects- first/middle/last

COG-SA- 27 Note: Teacher gets cut-out pictures from the box and lays them down on
the table.

Here are cut-out pictures of different objects. Group them according to

shapes. (triangle, rectangle, square, and circle)

27. Sorts objects based on shapes

COG-SA-28 Arrange the cut-out pictures of objects from smallest to biggest.

28. Arranges objects according to size from smallest to biggest

COG-SA-29 I have here a picture, get another picture on the table that is of the same size with
the one I am holding.

29. Matches objects according to size

COG-SA-30 Put together cut-out pictures that are red. Put together cut-out pictures that are
small.
30. Sorts objects based on 2 attributes (e.g. color & size)

COG-SA-31 Get three shapes with the same color.

31. Matches 2 – 3 colors

COG-RD-32 Name the letters of the alphabet.

32. Names the letters of the alphabet

COG-SA-33 Note: Teacher places letters M, R, S, T, A, and P on the table and

prepares the matching small letters with two distractor letters.

I have here 6 big letters of the alphabet. Get the small letters on the
table and match them with the big letters.

33. Matches big with small letters

COG-NU-34 Count from one to twenty.

34. Rote counts 1 to 20

COG-NU-35 Get three number cards from the treasure box one at a time and tell me what
number it is.

35. Identifies numbers from 1 to 20

COG-NU-36 Note: Place the number cards on the table. (2,5,7)

Get the popsicle sticks from the treasure box.

Show the number of popsicle sticks that matches the number on the
card.

COG-NU-37 Using popsicle sticks,

36. Associates add the1following:
numbers to 10 with objects

1) 8+ 2 =
2) 5+ 5 =
3) 1+ 9=
37. Adds objects to get a sum of 10

COG-NU-38 Using popsicle sticks, subtract the following:

1) 11 – 1 =
2) 12 – 2 =
3) 13 – 3 =

38. Subtracts objects to get a difference of 10.

COG-NU-39 Note: Follow the same instruction for the P10, P5, and P1 coins.

Get a 20-peso bill from the treasure box.

39. Identifies Philippine Peso Bills and Coins

COG-RE-40 What is/are the missing number/s? (1, 2, , 4, 5,

2, 4, 6, , 10, 12...
3, 6, , ...
5, , 15...)

40. Follows number patterns

COG- NU-41 Note: Teacher sets the time at 3:00, 7:00, and 9:00.

Look at the clock I am holding. Tell me what time it is.

41. Identifies time by the hour

COG-RE-42 Identify the events in the pictures. Which do you
think comes first? last? Arrange the pictures.

42. Sequences picture story of 4 to 6 events

COG-RE-43 Look at the pictures again. Tell me which event happened in the morning?
afternoon? night?

43. Identifies time concept of the day (morning, afternoon, night)

COG-RE-44 Arrange the puzzle to complete the picture.

44. Completes simple puzzles

COG-CL-45 Note: In case the learner was not able to do the puzzle, the teacher
shows the guide picture.

Point the head, neck, shoulder, hands, fingers, legs, knees and toes.

45. Identifies body parts

COG-CL-46 Which part of the body is for seeing? hearing? tasting? feeling? smelling?

46. Identifies five senses

COG-RE-47 Look at these two pictures. What are the differences between these pictures?

47. Identifies what is different in the picture

COG-RE-48 What is missing in the picture?

48. Identifies what is missing in the picture

COG-RT-49 Who are the members of your family?

49. Name members of the family.

COG-RD-50 Note: Observe the reaction of the learner and ask the learner which of
the two books he likes most?

Get 2 books from the treasure box.

50. Exhibits interest in books

Time Ended:

Directions: For Observation Checklist check (/) YES if observed and NO if not. Write in the ‘Remark

ITEM CODE OBSERVATION CHECKLIST

V 1. Does the learner hold the materials too close to his/her eyes?

V 2. Does the learner use his/her fingers to maintain place of

words/letters/lines while reading?
V 3. Does the learner rub eyes in an effort to see better?

V 4. Does the learner blink continuously?

V 5. Does the learner squint, cover or close his/her eyes while performing a
given task?
Cog 6. Does the learner have difficulty associate numbers with symbols?

Com 7. Does the learner have difficulty remembering things heard?

Com 8. Does the learner have difficulty giving appropriate response to

questions?
Cg 9. Does the learner have difficulty following a series of directions?

Cg-26 10. Does the learner have difficulty recalling information in the past?

Cg-31 11. Does the learner have difficulty giving appropriate response to
interview questions?
Cg-9 12. Does the learner have difficulty responding orally in identifying one -
word objects?
Cg-10 13. Does the learner repeat, omit or adds words when she/he answers?

Cg-9 14. Does the learner have difficulty responding orally in identifying one -
word objects?
Cg-10 15. Does the learner repeat, omit or adds words when s/he answers?

Cg-21 16. Does the learner have difficulty remembering names of body parts
and senses?

Activity 3 Title: MY DAIL

 ITEM CODE ASSESSMENT ACTIVITY
Time Started:
DLS-GH-51 Suppose you are taking a bath. Show me how you do it.

51. Takes a bath

DLS-GH-52 Show me how you brush your teeth.

52. Brushes own teeth

DLS-DR-53 Note: Teacher gives a polo shirt/blouse and
shorts/skirt/pants and ask the learner to stand and wear it.

Show me how you put on your clothes.

53. Puts on clothes.

DLS-DR-54 (If the learner does not button the clothes, the teacher may instruct the
learner to do the instruction below.)

Show me how to button your polo shirt/blouse.

Then show me how you unbutton your shirt/blouse.

54. Buttons and unbuttons clothes

DLS-DR-55 Note: Let the learner stand and demonstrate how to zip and unzip
pants/skirts/shorts.

Show me how to zip and unzip your pants/skirts/shorts.

55. Zips and unzips pants

DLS-DR-56 Show me how you take off your clothes.

56. Takes off clothes

DLS-DR-57 Show me how you put on your shoes.

57. Puts on shoes

DLS-DR-58 Note: If the learner is already wearing shoes with lace, ask the child to
untie first, then tie.
Show me how you tie your shoe lace. Then untie your shoe lace.

58. Ties and Unties shoe lace

DLS-GH-59 Note: Teacher will let the child demonstrate.

Show me how to comb or brush your hair.

59. Combs or brushes hair

DLS-GH-60 Note: Give the learner a handkerchief or a tissue paper.

Show me how you wipe or blow your nose using the tissue paper or
handkerchief.

60. Wipes / blows nose properly

DLS-GH-61 Note: Bring the child to the washroom.
If there is none, provide a pail of water, dipper, basin, soap, and towel.

Wash your hands, then dry them.

61. Washes and dries hands

DLS-FE-62 Note: Provide the learner with plate, spoon, fork, glass, and placemat.

Show me how to set the table.

62. Sets the table

DLS-FE-63 Note: Provide the learner with bread, sandwich spread in a bottle, and
spoon.

If the child is not exposed to preparing a sandwich, he/she may be

interviewed on other meals that he/she has prepared like cooking
egg/camote, etc.

Show me how to prepare a sandwich.

63. Prepares a 2-3 step meal

DLS-FE-64 Note: The assessor will provide any container that the learner will open
and close. This may be observed while the child is preparing the meal.

Show me how to open bottles/ jars and other food containers, then close
them.

64.Opens and closes bottles/jars/and food containers boxes/ food

DLS-FE-65 Note: The assessor will provide the table napkin/sandwich wrapper to the
learner.

Wrap your sandwich.

Now, you’re ready to eat your sandwich. Unwrap it.

65.Wraps /Unwraps

DLS-FE-66 Note: The assessor will verify this with the parent through observation

Do you consume the food on plate?

66.Consumes food on one’s plate

DLS-FE-67 Note: Validate through interview with the parent.

Can you serve yourself from a serving plate? Show me how.

67. Serves self from serving plate

DLS-FE-68 Note: The assessor will provide the eating utensils
to be used. Let the learner pretend using eating utensils.

Do you know how to use your eating utensils properly? Show me how.

68. Uses eating utensils properly

DLS-FE-69 Show me how you drink from a cup/glass/bottle.

69. Drinks from a cup/glass/ bottle

DLS-FE-70 Note: Validate through interview with the parents.

Do you clear your own place after eating at the table? Show me how.

70. Clears own place (at table) after eating

DLS-TL-71 Note: Compare answer with Activity 1 item no. 25. This may be observed
during the duration of the assessment.

Do you tell your teacher if you need to go to the toilet/CR?

71. Expresses the need to go to the toilet

DLS-TL-72 Note: Validate through interview with the parents. This may be observed
during the duration of the assessment.

Do you flush the toilet after using it?

72. Flushes toilet after use

DLS-TL-73 Note: Validate through interview with the parents. This may be observed
during the duration of the assessment.

After using the toilet, do you wash your hands?

73. Cleans self after toileting
DLS-HS-74 Note: Show 6 danger signs/symbols:
· slippery when wet
· high voltage
· poisonous/toxic
· flammable
· road under construction
· falling debris

Are you familiar with these symbols?

What does this symbol mean? When you see this, what should you do?

74. Identifies danger signs and symbols

DLS-HS-75 Here are pictures of broken glasses, high places, streets or sharp and
pointed objects. What will you do if you see these? Why?

75. Keeps out of danger, broken glass/high places, streets or sharp and
pointed objects
Time Ended:
Directions: For Observation Checklist check (/) YES if observed and NO if not. Write in the ‘Remark

ITEM CODE OBSERVATION CHECKLIST

1. Does the learner have difficulty in dressing?
Motor

Motor 2. Does the learner have difficulty going to the toilet independently?

Motor 3. Does the learner have difficulty accomplishing tasks using his/her fine
motor skills (e.g. unwrapping, shoe lacing, opening of bottle, etc. )

Activity 4 Title: WHETHER

ITEM CODE ASSESSMENT ACTIVITY
Time Started:
SEB-SS-76 Do you play with your friends? What games do you play?

76. Plays with peers

SEB-SS-77 Note: Interview the teacher adviser if the learner can follow rules during
games.

77. Follows rules and regulations.

SEB-SS-78 When is the best time to play with friends? Why?

78. Participates in the conversation

SEB-SS-79 Note: Interview the teacher adviser.

What do you do if you lose/win? Why?

79. Shows sportsmanship

SEB-SS-80 I have here pictures of different faces. Which of these shows the feeling when you
win? lose?

80. Expresses appropriate emotions

SEB-SS-81 Note: Let the learner name at least three friends.

How many friends do you have? Name them.

81. Makes friends easily

SEB-SS-82 What activities does your mother/father do at home? Show me how.

82. Imitates adult activities

SEB-ES-83 Do you have personal belongings? Name some of them.

83. Identifies personal belongings.

SEB-ES-84 Note: Free hand drawing.

How many are you in the family? Draw the members of your family.
Encircle where you are. (Items number 9 and 10)

84. Identifies self as a member of a family/cultural group

SEB-ES-85 Note: The teacher observes the behavior of the learner while doing the
activity number 9.

85. Shows initiative to work on tasks

SEB-ES-86 Note: The teacher gives constructive criticisms on the drawing. Refer to
Item number 9.

86. Accepts criticisms positively

SEB-ES-87 Note: Based on the reaction of the learner on item number 11.

87. Shows self-control

SEB-ES-88 Note: Prior knowledge of the teacher on the learner should be noted.
88. Engages in communication with others

SEB-SS-89 Note: The courteous expressions used by the learner.

How do you greet your teacher in the:

a) morning?
b) afternoon?

When you receive a gift, what will you say?

89. Uses courteous expressions appropriately

SEB-SS 90 If you accidentally bump somebody, what will you say?

90. Apologizes when necessary.

SEB-SS 91 Note: This can be observed during the administration. Does the learner
pay attention to someone who is talking?

91. Pays attention to someone talking

SEB-SS 92 If you have a difficult homework, what will you do?

92. Seeks or accepts help when he/she needs it.

SEB-SS 93 Prior knowledge of the teacher on the learner should be noted.

93. Waits for one’s turn

SEB-SS 94 Note: If not observed during the assessment, validate from the teacher.

94. Displays sense of humor

SEB-SS 95 Prior knowledge of the teacher on the learner should be noted.

95. Leads a group activity

SEB-SS 96 Prior knowledge of the teacher on the learner

should be noted.

96. Asks permission to use things owned by others

SEB-SS 97 Prior knowledge of the teacher on the learner should be noted.

97. Seeks older friends

SEB-SS 98 Prior knowledge of the teacher on the learner should be noted.

98. Prefers working alone

SEB-SS 99 Note: The teacher should act as one of the characters in the role playing.

I have four pictures here. Pick one and let’s act

it out.
a. At Home – mother cooking
b. School – teacher writing on the board
c. Playground - boy dribbling a ball
d. Market - mother buying vegetables

99. Participates in role play

SEB-ES-100 Note: Validate with the teacher.

If one of your classmates has no “baon”, what

should you do?

100. Displays sensitivity to the feelings of others

Time Ended:

Directions: For Observation Checklist check (/) YES if observed and NO if not. Write in the ‘Remark
ITEM CODE OBSERVATION CHECKLIST
Behaviour 1. Does the learner have difficulty concentrating on given tasks?

Behaviour 2. Does the learner have difficulty staying on his/her seat during the
activity?
Behaviour 3. Does the learner have short attention span?

Behaviour 4. Is the learner easily distracted with materials for the activity?

Behaviour 5. Does the learner easily get frustrated when s/he has difficulty
performing tasks?
Behaviour 6. Does the learner have difficulty identifying things used for personal
hygiene?
Behaviour 7. Does the learner have difficulty giving appropriate response to
questions about his/her feelings in given situations?
Behaviour 8. Does the learner have difficulty displaying interest in activities related
with people, friends and play?
Behaviour 9. Does the learner have difficulty articulating in expressing his/her
thoughts?
Behaviour 10. Does the learner have difficulty giving appropriate response to
questions about his/her feelings in given situations?
Behaviour 11. Does the learner shout during the activity?
 Activity 5A Title: WORK
ITEM CODE ASSESSMENT ACTIVITY
Time Started:
MSF-101 I have here a
whole sheet of bond paper. Fold it once in any direction.

101. Folds paper into a shape

MSF-102 Then, tear the paper following the fold you made.

102. Tears papers in simple shapes

MSF-103 Here are pictures of a ball and a glass.

Trace the broken, straight, and curve lines. (For item 17-18)

103.Traces broken-straight and curved lines

MSF-104 104.Traces continuous- straight and curved lines

MSF-105 Color them.

105. Colors objects

MSF-106 Cut the lines of the glass you traced and colored. (Items 20-22)

106.Cuts paper in straight direction

MSF-107 107.Cuts paper in curved direction

MSF-108 108. Cuts pictures within a given line

MSF-109 Draw a house using different shapes.

109.Draws a combination of shapes

MSF-110 Note: Observe whether the learner can hold a pencil/drawing tool using a
tripod grip while drawing a house.

110. Holds pencil and a drawing tool using a tripod grip

MSF-111 Copy these letters (B, G and R) on your paper.

111. Copies letters

Time Ended:

Directions: For Observation Checklist check (/) YES if observed and NO if not. Write in the ‘Remark
ITEM CODE OBSERVATION CHECKLIST

Motor 1. Does the learner display poor eye-hand coordination?

Motor 2. Does the learner have difficulty coloring within the lines?

Motor 3. Does the learner drool excessively?/ Does saliva come out of the
learner’s mouth?
Motor 4. Does the learner have difficulty in tracing activities?

Motor 5. Does the learner have difficulty in holding the scissors?

 Activity 5B Title: LET’S GET
ITEM CODE ASSESSMENT ACTIVITY
Time Started:
MSG-112 Stand properly for 5 seconds.

112. Stands with normal stance

MSG-113 Stand on one foot without support with your eyes closed for 10 seconds.

113. Stands on one foot without support for 10 seconds with eyes closed
MSG-114 Stand on one foot, then tip toe.

114. Stands on one foot and on tiptoe

MSG-115 Now, march in place for five seconds.

115. Marches in place

MSG-116 Note: Bring the learner to the area where the straight line marking is.

Walk forward on the straight line.

116. Walks in a straight line with correct stepping pattern,
MSG-117 Now, step backward. Then take three steps sideward (R/L).

117. Walks sideward and backwards with correct stepping pattern

MSG-118 Hop in place three times.

118. Hops in place

MSG-119 Note: Teacher points where to start.

Skip three times following the line.

119. Skips within a given path

MSG-120 Gallop five steps sideward (R/L).

120. Gallops sideward

MSG-121 Show me your highest jump. How about your longest jump?

121. Jumps for distance and for a height

MSG-122 Note: Arrange the 3 chairs 1 meter away from each other. Place the ball
on the floor 1 meter away from the last chair. Tell the learner to run
passing through the chairs without tumbling and ask him/her to pick up
the ball and back to the starting point going through the same obstacle.
Remind the learner to be careful. (Items 11-12)

Run passing the three chairs in zigzag manner, get the ball and run back
in the same way. Be careful.

122. Runs at a given distance and picks up a ball in an obstacle course.

MSG-123 Note: Stand at least 3 meters away from the learner.

Catch the ball and throw it back to me.

123. Throws and catches a ball

MSG-124 Kick the ball forward. This time, kick the ball sideward (R/L).

124. Kicks forward and sideward

MSG-125 Note: Bring the learner to the stairs.

Go upstairs with one hand holding the rail, then go down.

This time, go up and down the stairs without holding the rail.

125. Climbs upstairs and goes downstairs with

one hand holding the rail and without holding the rail.

Time Ended:

Directions: For Observation Checklist check (/) YES if observed and NO if not. Write in the ‘Remark
ITEM CODE OBSERVATION CHECKLIST
Motor 1. Does the learner have difficulty in balancing?

Motor 2. Does the learner have difficulty following instructions in performing motor
activities?
Motor 3. Does the learner have difficulty in balancing?
 LRN:

Kapampangan
Bicol
Hiligaynon
Maguindanaoan

LRN
observed. If not, check NO and write in the learner’s response column the behavior manifested by the learner towards the given

Time Ended:

Activity 1 Title: LET’S TALK

YES NO LEARNER’S RESPONSE
f not. Write in the ‘Remarks’ column, significant observations during the conduct of the activity.

YES NO REMARKS

Activity 2 Title: TREASURE BOX

YES NO LEARNER’S RESPONSE
f not. Write in the ‘Remarks’ column, significant observations during the conduct of the activity.

YES NO REMARKS

ctivity 3 Title: MY DAILY ROUTINE

YES NO LEARNER’S RESPONSE
f not. Write in the ‘Remarks’ column, significant observations during the conduct of the activity.

YES NO REMARKS

Activity 4 Title: WHETHER WEATHER

YES NO LEARNER’S RESPONSE
f not. Write in the ‘Remarks’ column, significant observations during the conduct of the activity.
YES NO REMARKS
Activity 5A Title: WORK OF HANDS
YES NO LEARNER’S RESPONSE

f not. Write in the ‘Remarks’ column, significant observations during the conduct of the activity.
YES NO REMARKS
ctivity 5B Title: LET’S GET PHYSICAL!
YES NO LEARNER’S RESPONSE
f not. Write in the ‘Remarks’ column, significant observations during the conduct of the activity.
YES NO REMARKS
 Pangasinense
Chavacano
Waray
Maranao

avior manifested by the learner towards the given

INTERVENTION/S
ng the conduct of the activity.

REMARKS

INTERVENTION/S
ng the conduct of the activity.

REMARKS
INTERVENTION/S
ng the conduct of the activity.

REMARKS

INTERVENTION/S
ng the conduct of the activity.
REMARKS
 INTERVENTION/S

ng the conduct of the activity.

REMARKS
INTERVENTION/S
ng the conduct of the activity.
REMARKS
Form B: SCHOOL PROFILE

Division: District: District: School ID:

School Name: Name of School Head:

School Address:

Contact Number of School:

Type of School:

Central School
Non-Central School
Mono-Grade
Multi-Grade

Number of Teachers and Learners

Level Number of Learners Number of Teachers

Grade 1
Total
Form D1: SUMMARY OF MFAT RESULTS

Instruction: Write the number of learners with difficulty in doing the task per item per competency
Communication Cognitive Daily Living Skill
No. of No. of learners No. of No. of learners No. of
items M F T items M F T items
1 0 26 0 51
2 0 27 0 52
3 0 28 0 53
4 0 29 0 54
5 0 30 0 55
6 0 31 0 56
7 0 32 0 57
8 0 33 0 58
9 0 34 0 59
10 0 35 0 60
11 0 36 0 61
12 0 37 0 62
13 0 38 0 63
14 0 39 0 64
15 0 40 0 65
16 0 41 0 66
17 0 42 0 67
18 0 43 0 68
19 0 44 0 69
20 0 45 0 70
21 0 46 0 71
22 0 47 0 72
23 0 48 0 73
24 0 49 0 74
25 0 50 0 75

Prepared by:

NAME OF GRADE 1 TEACHER

Position
tency
Daily Living Skills Motor Skills Socio-Emotional Behavior
No. of learners No. of No. of learners No. of No. of learners
M F T items M F T items M
0 76 0 101
0 77 0 102
0 78 0 103
0 79 0 104
0 80 0 105
0 81 0 106
0 82 0 107
0 83 0 108
0 84 0 109
0 85 0 100
0 86 0 111
0 87 0 112
0 88 0 113
0 89 0 114
0 90 0 115
0 91 0 116
0 92 0 117
0 93 0 118
0 94 0 119
0 95 0 120
0 96 0 121
0 97 0 122
0 98 0 123
0 99 0 124
0 100 0 125

Noted:

NAME OF SCHOOL HEAD

Position
o-Emotional Behavior
No. of learners
F T
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Form D2: SUMMARY OF MFAT RESULTS
School: ____________________________________
District: ____________________________________
Instruction: Write the number of learners with difficulty in doing the task per item per competency, the type of intevention used
Communication
No. of learners who
No. of Learners who exhibit
No. of responded positively to
developmental delay Intervention
Items intervention
M F T M
1 0 1 1 0
2 0
3 0
4 0
5 0
6 0
7 0
8 0
9 0
10 0
11 0
12 0
13 0
14 0
15 0
16 0
17 0
18 0
19 0
20 0
21 0
22 0
23 0
24 0
25 0

Motor Skills
No. of learners who
No. of Learners who exhibit
No. of responded positively to
developmental delay Intervention
Items intervention
M F T M
76 0
77 0
78 0
79 0
80 0
81 0
82 0
83 0
84 0
85 0
86 0
87 0
88 0
89 0
90 0
91 0
92 0
93 0
94 0
95 0
96 0
97 0
98 0
99 0
100 0

Prepared by:

NAME OF GRADE 1 TEACHER

Position
ncy, the type of intevention used to addressed the difficulty of each learner and the number of learners who responded positively to the inte
n C
No. of learners who No. of learners No. of Learners who
No. of
responded positively to the recommended for further exhibit developmental
Items
intervention evaluation delay
F T M F T M F T
1 1 0 0 0 26
0 0 27
0 0 28
0 0 29
0 0 30
0 0 31
0 0 32
0 0 33
0 0 34
0 0 35
0 0 36
0 0 37
0 0 38
0 0 39
0 0 40
0 0 41
0 0 42
0 0 43
0 0 44
0 0 45
0 0 46
0 0 47
0 0 48
0 0 49
0 0 50

No. of learners who No. of learners No. of Learners who

responded positively to the recommended for further No. of exhibit developmental
intervention evaluation Items delay
F T M F T M F T
0 0 101 0
0 0 102 0
0 0 103 0
0 0 104 0
0 0 105 0
0 0 106 0
 0 0 107 0
0 0 108 0
0 0 109 0
0 0 100 0
0 0 111 0
0 0 112 0
0 0 113 0
0 0 114 0
0 0 115 0
0 0 116 0
0 0 117 0
0 0 118 0
0 0 119 0
0 0 120 0
0 0 121 0
0 0 122 0
0 0 123 0
0 0 124 0
0 0 125 0

OF GRADE 1 TEACHER
Position
ded positively to the intervention
Cognitive
No. of learners who No. of learners
responded positively to the recommended for further
Intervention
intervention evaluation
M F T M F

Socio-Emotional Behavior
No. of learners who No. of learners
responded positively to the recommended for further
Intervention
intervention evaluation
M F T M F
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
 Daily Living Skills
of learners No. of Learners who
No. of
nded for further exhibit developmental
Items Intervention
valuation delay
T M F T
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75

of learners
nded for further
valuation
T
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

Noted:

NAME OF SCHOOL HEAD

Position
 No. of learners who No. of learners
responded positively to the recommended for further
intervention evaluation
M F T M F T