Before you go around your community to conduct your early registration activities, coordinate with the District or Division

office and your barangay. If there are other schools in your barangay, coordinate with them as well.

Distribute this child mapping tool to your team of teachers and volunteers. They should fill this up as they move from house to house in the barangay. This will help you get important basic information on the status of 4-17 year old children in your community which you can use in school planning. You only need to cover your barangay unless majority of your students
come from nearby communities, in which case, you need to conduct child mapping in those barangays as well. If there are no schools in a barangay, the District or Division office will initiate the child mapping in that area (following DO. No. 1 s. 2015).
Child mapping should be done at least every 3 years (preferably at the start of the SIP cycle), assuming that there are no major changes in the population of your community. After events causing major population changes (e.g. disasters), child mapping should be conducted to account for the children in your community.

After mapping, consolidate the data. You can encode it in the School-Community Data Template for easy reference. Share the data with your District and Division offices, barangay, and with nearby schools and communities.

Barangay: __MABULITEC___ Division: __SDO1 PANGASINAN___

Municipality: __MALASIQUI__ Region: _____________I_______________
TOOL FOR MAPPING OF 4-17 YR. OLD CHILDREN

NAME DEMOGRAPHIC INFORMATION RESIDENCE DISABILITY ECCD (FOR 4YO CHILDREN) EDUCATIONAL STATUS

If YES, Planning to
With Birth Number of Is residence Has a Provided Currently study next
years in permanent?1 specify with ECCD Educational If YES, specify name of If NO, state reason for not If studying through ADM,
Last First Middle Gender Age Date of birth Certificate? Present address present disability? type of Services? If YES, specify ECCD facility studying? school studying specify type of ADM school
(YES/NO) (YES/NO) (YES/NO) attainment3 (YES/NO) year?
address disability 2
(YES/NO)
(YES/NO)

DE VERA GALE AHESHA D F 4 9/8/2014 YES #155 MABULITEC, MALASIQUI, PANGASINAN 4 YES

DE VERA GLENFORD D M 5 7/7/2010 YES #155 MABULITEC, MALASIQUI, PANGASINAN 7 YES

DE VERA JANSEN D M 7 7/16/2012 YES #155 MABULITEC, MALASIQUI, PANGASINAN 5 YES

ESPIRITU MARY JOYCE A F 7 6/11/2010 YES #170 MABULITEC, MALASIQUI, PANGASINANA 3 YES

ESPIRITU PATRICK JESRIL P M 9 4/12/2009 YES #03 MABULITEC, MALASIQUI, PANGASINAN 9 YES

CUSTODIO CATHLEA JOYCE T F 9 9/8/2013 YES #172 MABULITEC, MALASIQUI, PANGASINAN 9 YES

DE VERA JUSTINE BLANCE D M 10 7/2/2008 YES #155 MABULITEC, MALASIQUI, PANGASINAN 10 YES

ESPIRITU PRECIOUS A F 10 6/27/2006 YES #170 MABULITEC, MALASIQUI, PANGASINANA 3 YES

REYES IRISH MAE M F 10 5/9/2008 YES #161 MABULITEC, MALASIQUI, PANGASINAN 10 YES

CAGUNOT JOSE GABRIEL E M 11 12/20/2006 YES #04 MABULITEC, MALASIQUI, PANGASINAN 11 YES

CAGUNOT JOSE JEMUEL E M 11 12/20/2006 YES #04 MABULITEC, MALASIQUI, PANGASINAN 11 YES

CUSTODIO NICOLE KIM T F 11 8/4/2006 YES #172 MABULITEC, MALASIQUI, PANGASINAN 11 YES
2
TYPES OF DISABILITIES: (see DepED Order No. 2, s 2014 for detailed descriptions)
1- Visual Impairment 6- Serious emotional disturbance
2- Hearing Impairment 7- Autism INTERVIEWER NAME AND SIGNATURE
3- Intellectual Disability 8- Orthopedic impairment
4- Learning Disability 9- Special health problems
5- Speech/language impairment 10- Multiple disabilities

3
EDUCATIONAL ATTAINMENT:
CK- Completed Kindergarten C7- Completed Grade 7 SK- Some Kindergarten S7- Some Grade 7
C1- Completed Grade 1 C8- Completed Grade 8 S1- Some Grade 1 S8- Some Grade 8 21-May-18
C2- Completed Grade 2 C9- Completed Grade 9 S2- Some Grade 2 S9- Some Grade 9 DATE OF INTERVIEWS
C3- Completed Grade 3 C10- Completed Grade 10 S3- Some Grade 3 S10- Some Grade 10
C4- Completed Grade 4 C11- Completed Grade 11 S4- Some Grade 4 S11- Some Grade 11
C5- Completed Grade 5 C12- Completed Grade 12 S5- Some Grade 5 S12- Some Grade 12
C6- Completed Grade 6 S6- Some Grade 6
 NAME DEMOGRAPHIC INFORMATION RESIDENCE DISABILITY ECCD (FOR 4YO CHILDREN) EDUCATIONAL STATUS

Number of Is residence If YES, Provided Planning to

With Birth Has a Currently study next
Certificate? years in disability? specify with ECCD Educational studying? If YES, specify name of If NO, state reason for not If studying through ADM, school
Last First Middle Gender Age Date of birth Present address present permanent?
1
type of Services? If YES, specify ECCD facility attainment3 school studying specify type of ADM
(YES/NO) (YES/NO) (YES/NO) (YES/NO) year?
address disability2 (YES/NO) (YES/NO)

MAGALONG NEIL PATRICK D M 5 2/22/2013 #163 MABULITEC, MALASIQUI, PANGASINAN 5 YES

SALINAS JOVANE V M 8 1/12/2010 MABULITEC, MALASIQUI, PANGASINAN 8 YES

MACARAEG PRINCESS MOIRA R F 9 5/15/2009 #174 MABULITEC, MALASIQUI, PANGASINAN 9 YES

MACASIEB CRISSA JAE N F 9 4/12/2009 #176 MABULITEC, MALASIQUI, PANGASINAN 9 YES

GARCIA JOVANE DAVE E M 9 4/11/2009 #178 MABULITEC, MALASIQUI, PANGASINAN 9 YES

SALINAS AR-JAY A M 11 2/15/2007 #169 MABULITEC, MALASIQUI, PANGASINAN 11 YES

MACARAEG MEIHAN R F 11 4/28/2007 #174 MABULITEC, MALASIQUI, PANGASINAN 11 YES

GARCIA ZOEN P M 11 12/14/2007 #178 MABULITEC, MALASIQUI, PANGASINAN 11 YES

SALINAS BEVERLY A F 12 10/9/2005 #169 MABULITEC, MALASIQUI, PANGASINAN 12 YES

MACARAEG ANGELO JAY R M 12 3/25/2006 #174 MABULITEC, MALASIQUI, PANGASINAN 12 YES

BATAAN ROCHELLE C F 12 1/8/2006 MABULITEC, MALASIQUI, PANGASINAN 25 C6 YES

BATAAN KRISTINE D F 13 9/18/2004 MABULITEC, MALASIQUI, PANGASINAN 25 C7 YES

ASK: "Is the child a permanent resident?" (YES/NO) If YES, follow up "do the residents plan on moving out?"
1

2
TYPES OF DISABILITIES: (see DepED Order No. 2, s 2014 for detailed descriptions) INTERVIEWER NAME AND SIGNATURE
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

3
EDUCATIONAL ATTAINMENT: 21-May-18
CK- Completed Kindergarten C7- Completed Grade 7 SK- Some Kindergarten S7- Some Grade 7 DATE OF INTERVIEWS
C1- Completed Grade 1 C8- Completed Grade 8 S1- Some Grade 1 S8- Some Grade 8
C2- Completed Grade 2 C9- Completed Grade 9 S2- Some Grade 2 S9- Some Grade 9
C3- Completed Grade 3 C10- Completed Grade 10 S3- Some Grade 3 S10- Some Grade 10
C4- Completed Grade 4 C11- Completed Grade 11 S4- Some Grade 4 S11- Some Grade 11
C5- Completed Grade 5 C12- Completed Grade 12 S5- Some Grade 5 S12- Some Grade 12
C6- Completed Grade 6 S6- Some Grade 6
 NAME DEMOGRAPHIC INFORMATION RESIDENCE DISABILITY ECCD (FOR 4YO CHILDREN) EDUCATIONAL STATUS

Number of If YES, Provided Planning to

With Birth years in Is residence Has a specify with ECCD Educational Currently If YES, specify name of If NO, state reason for not If studying through ADM, study next
Last First Middle Gender Age Date of birth Certificate? Present address present permanent?
1
disability? type of Services? If YES, specify ECCD facility attainment3 studying? school studying specify type of ADM school
(YES/NO) address (YES/NO) (YES/NO) disability2 (YES/NO) (YES/NO) year?
(YES/NO)

SANTOS JUSTIN O M 5 6/26/2013 MABULITEC, MALASIQUI, PANGASINAN 10 YES NO DAYCARE NO

LOZADA JOHN MICHAEL V M 6 10/10/2011 MABULITEC, MALASIQUI, PANGASINAN 25 NO CK YES MABULITEC INTEGRATED SCHOOL YES

PINLAC JOVENSON F M 6 4/6/2012 MABULITEC, MALASIQUI, PANGASINAN 6 YES NO DAYCARE CK YES YES

NAVATA RONALDO E M 8 10/29/2009 MABULITEC, MALASIQUI, PANGASINAN 2 YES NO C1 YES YES

PINLAC RODRIGO A M 8 8/15/2009 MABULITEC, MALASIQUI, PANGASINAN YES NO C3 YES YES

PINLAC JONATHAN F M 8 9/28/2009 MABULITEC, MALASIQUI, PANGASINAN YES NO C3 YES

PINLAC JOHN DAVID N M 9 5/24/2008 MABULITEC, MALASIQUI, PANGASINAN 15 YES NO C2 YES YES

PINLAC ANDRO L M 11 10/27/2006 MABULITEC, MALASIQUI, PANGASINAN 25 NO C5 YES MABULITEC INTEGRATED SCHOOL YES

PINLAC ROXANNE N F 12 12/6/2005 MABULITEC, MALASIQUI, PANGASINAN 15 YES NO C5 YES YES

PINLAC ABEGAIL P F 13 3/29/2005 MABULITEC, MALASIQUI, PANGASINAN 22 C7 YES MABULITEC INTEGRATED SCHOOL YES

PINLAC ARJAY V M 13 2/24/2005 MABULITEC, MALASIQUI, PANGASINAN 13 NO C7 YES MABULITEC INTEGRATED SCHOOL YES

PINLAC ROWEL N M 13 2/4/2005 MABULITEC, MALASIQUI, PANGASINAN 15 YES NO C7 YES YES

ASK: "Is the child a permanent resident?" (YES/NO) If YES, follow up "do the residents plan on moving out?"
1

2
TYPES OF DISABILITIES: (see DepED Order No. 2, s 2014 for detailed descriptions) INTERVIEWER NAME AND SIGNATURE
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

3
EDUCATIONAL ATTAINMENT: 21-May-18
CK- Completed Kindergarten C7- Completed Grade 7 SK- Some Kindergarten S7- Some Grade 7 DATE OF INTERVIEWS
C1- Completed Grade 1 C8- Completed Grade 8 S1- Some Grade 1 S8- Some Grade 8
C2- Completed Grade 2 C9- Completed Grade 9 S2- Some Grade 2 S9- Some Grade 9
C3- Completed Grade 3 C10- Completed Grade 10 S3- Some Grade 3 S10- Some Grade 10
C4- Completed Grade 4 C11- Completed Grade 11 S4- Some Grade 4 S11- Some Grade 11
C5- Completed Grade 5 C12- Completed Grade 12 S5- Some Grade 5 S12- Some Grade 12
C6- Completed Grade 6 S6- Some Grade 6
 NAME DEMOGRAPHIC INFORMATION RESIDENCE DISABILITY ECCD (FOR 4YO CHILDREN) EDUCATIONAL STATUS

Planning to
With Birth Number of Is residence Has a If YES, Provided Currently study next
Last First Middle Gender Age Date of birth Certificate? Present address years in permanent?1 disability? specify with ECCD If YES, specify ECCD facility Educational studying? If YES, specify name of If NO, state reason for not If studying through ADM, school
present type of Services? attainment3 school studying specify type of ADM
(YES/NO) (YES/NO) (YES/NO) (YES/NO) year?
address disability2 (YES/NO) (YES/NO)

ESPIRITU FRANKLIN V M 4 3/3/2014 YES #171 MABULITEC, MALASIQUI, PANGASINAN 4 NO YES

AGBUYA ANGELO I M 4 5/6/2014 YES 4 NO YES

ABALOS KRISHA MAE E F 4 1/6/2014 YES 4 NO YES MABULITEC INTEGRATED SCHOOL YES

MAGALONG PRINCESS BRITHEA P F 4 12/12/2013 YES 4 NO YES MABULITEC INTEGRATED SCHOOL YES

PINLAC JAMES L M 7 8/16/2010 MABULITEC, MALASIQUI, PANGASINAN YES NO C2 YES MABULITEC INTEGRATED SCHOOL YES

MAGNO KENNETH C M 7 9/24/2010 YES 7 NO YES MABULITEC INTEGRATED SCHOOL YES

MAGALONG KIANA LEE P F 7 9/20/2010 YES 7 NO YES MABULITEC INTEGRATED SCHOOL YES

PINLAC SYRAH F F 11 7/18/2006 MABULITEC, MALASIQUI, PANGASINAN

PINLAC VIRGILIO, JR. L M 11 7/27/2006 MABULITEC, MALASIQUI, PANGASINAN YES NO C6 YES MABULITEC INTEGRATED SCHOOL YES

AGBUYA VERONICA D F 12 10/25/2005 YES 12 NO YES MABULITEC INTEGRATED SCHOOL YES

MAGNO CHRISTIAN JAY C M 12 9/18/2005 YES 12 NO YES MABULITEC INTEGRATED SCHOOL YES

PINLAC HANNA NICOLE L F MABULITEC, MALASIQUI, PANGASINAN YES NO CK YES MABULITEC INTEGRATED SCHOOL YES

ASK: "Is the child a permanent resident?" (YES/NO) If YES, follow up "do the residents plan on moving out?"
1

2
TYPES OF DISABILITIES: (see DepED Order No. 2, s 2014 for detailed descriptions) INTERVIEWER NAME AND SIGNATURE
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

3
EDUCATIONAL ATTAINMENT: 21-May-18
CK- Completed Kindergarten C7- Completed Grade 7 SK- Some Kindergarten S7- Some Grade 7 DATE OF INTERVIEWS
C1- Completed Grade 1 C8- Completed Grade 8 S1- Some Grade 1 S8- Some Grade 8
C2- Completed Grade 2 C9- Completed Grade 9 S2- Some Grade 2 S9- Some Grade 9
C3- Completed Grade 3 C10- Completed Grade 10 S3- Some Grade 3 S10- Some Grade 10
C4- Completed Grade 4 C11- Completed Grade 11 S4- Some Grade 4 S11- Some Grade 11
C5- Completed Grade 5 C12- Completed Grade 12 S5- Some Grade 5 S12- Some Grade 12
C6- Completed Grade 6 S6- Some Grade 6
 NAME DEMOGRAPHIC INFORMATION RESIDENCE DISABILITY ECCD (FOR 4YO CHILDREN) EDUCATIONAL STATUS

Number of If YES, Provided Planning to

With Birth years in Is residence Has a specify with ECCD Educational Currently If YES, specify name of If NO, state reason for not If studying through ADM, study next
Last First Middle Gender Age Date of birth Certificate? Present address present permanent?
1
disability? type of Services? If YES, specify ECCD facility attainment3 studying? school studying specify type of ADM school
(YES/NO) address (YES/NO) (YES/NO) disability2 (YES/NO) (YES/NO) year?
(YES/NO)

BUGAYONG JOSHUA C M 5 3/10/2013 YES 5 NO YES MABULITEC INTEGRATED SCHOOL YES

FABROS ANGELINE T F 5 1/28/2013 YES 5 NO YES APAYA, MALASIQUI, PANGASINAN YES

SALINAS KIM EMMANUEL V M 5 11/24/2012 YES 5 NO YES MALASIQUI CATHOLIC SCHOOL YES

MELAD ANDREI M M 6 5/11/2012 YES 6 NO YES MABULITEC INTEGRATED SCHOOL YES

EBALOBO NEIL A M 6 9/18/2011 YES 6 NO YES MABULITEC INTEGRATED SCHOOL YES

FABROS JOHN DENVER T M 7 8/28/2010 YES 7 NO YES APAYA, MALASIQUI, PANGASINAN YES

SERVIDAD KATE ASHLEY A F 7 6/8/2010 YES 7 NO YES MABULITEC INTEGRATED SCHOOL YES

MELAD ALEXA M F 8 4/18/2010 YES 8 NO YES MABULITEC INTEGRATED SCHOOL YES

AGBUYA SHERWIN P M 9 12/1/2009 YES 9 NO YES MABULITEC INTEGRATED SCHOOL YES

MACARAEG TRIXIA M F 11 1/13/2007 YES 11 NO YES MABULITEC INTEGRATED SCHOOL YES

SERVIDAD KURT ADRIAN A M 12 1/1/2006 YES 12 NO YES MABULITEC INTEGRATED SCHOOL YES

MACARAEG SHEILA MAE M F 13 12/11/2004 YES 13 NO YES MABULITEC INTEGRATED SCHOOL YES

ASK: "Is the child a permanent resident?" (YES/NO) If YES, follow up "do the residents plan on moving out?"
1

2
TYPES OF DISABILITIES: (see DepED Order No. 2, s 2014 for detailed descriptions) INTERVIEWER NAME AND SIGNATURE
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

3
EDUCATIONAL ATTAINMENT: 21-May-18
CK- Completed Kindergarten C7- Completed Grade 7 SK- Some Kindergarten S7- Some Grade 7 DATE OF INTERVIEWS
C1- Completed Grade 1 C8- Completed Grade 8 S1- Some Grade 1 S8- Some Grade 8
C2- Completed Grade 2 C9- Completed Grade 9 S2- Some Grade 2 S9- Some Grade 9
C3- Completed Grade 3 C10- Completed Grade 10 S3- Some Grade 3 S10- Some Grade 10
C4- Completed Grade 4 C11- Completed Grade 11 S4- Some Grade 4 S11- Some Grade 11
C5- Completed Grade 5 C12- Completed Grade 12 S5- Some Grade 5 S12- Some Grade 12
C6- Completed Grade 6 S6- Some Grade 6
 NAME DEMOGRAPHIC INFORMATION RESIDENCE DISABILITY ECCD (FOR 4YO CHILDREN) EDUCATIONAL STATUS

Planning to
With Birth Number of Is residence Has a If YES, Provided Currently study next
Last First Middle Gender Age Date of birth Certificate? Present address years in permanent?1 disability? specify with ECCD If YES, specify ECCD facility Educational studying? If YES, specify name of If NO, state reason for not If studying through ADM, school
present type of Services? attainment3 school studying specify type of ADM
(YES/NO) address (YES/NO) (YES/NO) (YES/NO) year?
disability2 (YES/NO) (YES/NO)

NEVADO JOHN JACOB C M 4 7/26/2014 YES 4 YES

DE GUZMAN JOHN JACOB F M 7 12/27/2010 MABULITEC, MALASIQUI, PANGASINAN C1 YES MABULITEC INTEGRATED SCHOOL YES

ARMAS MA. LUISITA A F 9 11/24/2008 MABULITEC, MALASIQUI, PANGASINAN YES MABULITEC INTEGRATED SCHOOL YES

PAGUIGAN MARK ANDREI A M 9 9/13/2008 MABULITEC, MALASIQUI, PANGASINAN YES

DE GUZMAN ADRIAN JAMES F M 9 6/1/2009 MABULITEC, MALASIQUI, PANGASINAN C3 YES MABULITEC INTEGRATED SCHOOL YES

MENDOZA DANIELA ANN F 10 8/8/2007 MABULITEC, MALASIQUI, PANGASINAN C5 YES MABULITEC INTEGRATED SCHOOL YES

DE GUZMAN ALEXES R M 10 9/4/2007 MABULITEC, MALASIQUI, PANGASINAN C5 YES MABULITEC INTEGRATED SCHOOL YES

PAGUIGAN ROSA MIA A F 11 7/18/2006 MABULITEC, MALASIQUI, PANGASINAN YES

DE GUZMAN ALYSSA R F 11 7/19/2006 MABULITEC, MALASIQUI, PANGASINAN YES

ARMAS BEVERLY F F 12 3/1/2006 YES MABULITEC, MALASIQUI, PANGASINAN YES NO C6 YES MABULITEC INTEGRATED SCHOOL YES

FRIAZ JOHN MARK B M 13 9/9/2004 MABULITEC, MALASIQUI, PANGASINAN YES MABULITEC INTEGRATED SCHOOL YES

DE GUZMAN ARA JANE R F 13 10/24/2004 MABULITEC, MALASIQUI, PANGASINAN YES

ASK: "Is the child a permanent resident?" (YES/NO) If YES, follow up "do the residents plan on moving out?"
1

2
TYPES OF DISABILITIES: (see DepED Order No. 2, s 2014 for detailed descriptions) INTERVIEWER NAME AND SIGNATURE
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

3
EDUCATIONAL ATTAINMENT: 21-May-18
CK- Completed Kindergarten C7- Completed Grade 7 SK- Some Kindergarten S7- Some Grade 7 DATE OF INTERVIEWS
C1- Completed Grade 1 C8- Completed Grade 8 S1- Some Grade 1 S8- Some Grade 8
C2- Completed Grade 2 C9- Completed Grade 9 S2- Some Grade 2 S9- Some Grade 9
C3- Completed Grade 3 C10- Completed Grade 10 S3- Some Grade 3 S10- Some Grade 10
C4- Completed Grade 4 C11- Completed Grade 11 S4- Some Grade 4 S11- Some Grade 11
C5- Completed Grade 5 C12- Completed Grade 12 S5- Some Grade 5 S12- Some Grade 12
C6- Completed Grade 6 S6- Some Grade 6

NAME DEMOGRAPHIC INFORMATION RESIDENCE DISABILITY ECCD (FOR 4YO CHILDREN) EDUCATIONAL STATUS

Number of If YES, Provided Planning to

With Birth years in Is residence Has a specify with ECCD Educational Currently If YES, specify name of If NO, state reason for not If studying through ADM, study next
Last First Middle Gender Age Date of birth Certificate? Present address present permanent?
1
disability? type of Services? If YES, specify ECCD facility attainment3 studying? school studying specify type of ADM school
(YES/NO) (YES/NO) (YES/NO) (YES/NO) year?
address disability2 (YES/NO) (YES/NO)

ARMAS CALVIN REIN F M 5 7/5/2012 YES MABULITEC, MALASIQUI, PANGASINAN YES NO CK YES MABULITEC INTEGRATED SCHOOL YES

LLAMIDO VAL KRAVEN N M 5 2/14/2013 YES MABULITEC, MALASIQUI, PANGASINAN

BORCELO AARON A M 7 3/26/2011

MAGDAYO JAKE CHA M M 9 11/12/2008 MABULITEC, MALASIQUI, PANGASINAN

MOVIDA RONA MAE V F 9 5/6/2009

BORCELO GABRIEL A M 10 3/31/2008

DE VERA SHANELL A F 10 8/10/2007

MAGDAYO JOVEN M M 11 10/11/2006 MABULITEC, MALASIQUI, PANGASINAN

LAMBINO DELFIN I M 12 10/26/2005 MABULITEC, MALASIQUI, PANGASINAN C5

BORCELO ELLAIN REGINA A F 13 3/4/2005

FERRER JUPITER F M 13 7/24/2004

LAMBINO DEN MARK I M MABULITEC, MALASIQUI, PANGASINAN YES NO C1 YES MABULITEC INTEGRATED SCHOOL YES

ASK: "Is the child a permanent resident?" (YES/NO) If YES, follow up "do the residents plan on moving out?"
1

2
TYPES OF DISABILITIES: (see DepED Order No. 2, s 2014 for detailed descriptions) INTERVIEWER NAME AND SIGNATURE
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

3
EDUCATIONAL ATTAINMENT: 21-May-18
CK- Completed Kindergarten C7- Completed Grade 7 SK- Some Kindergarten S7- Some Grade 7 DATE OF INTERVIEWS
C1- Completed Grade 1 C8- Completed Grade 8 S1- Some Grade 1 S8- Some Grade 8
C2- Completed Grade 2 C9- Completed Grade 9 S2- Some Grade 2 S9- Some Grade 9
C3- Completed Grade 3 C10- Completed Grade 10 S3- Some Grade 3 S10- Some Grade 10
C4- Completed Grade 4 C11- Completed Grade 11 S4- Some Grade 4 S11- Some Grade 11
C5- Completed Grade 5 C12- Completed Grade 12 S5- Some Grade 5 S12- Some Grade 12
C6- Completed Grade 6 S6- Some Grade 6

NAME DEMOGRAPHIC INFORMATION RESIDENCE DISABILITY ECCD (FOR 4YO CHILDREN) EDUCATIONAL STATUS

Planning to
With Birth Number of Is residence Has a If YES, Provided Currently study next
years in permanent?1 specify with ECCD Educational If YES, specify name of If NO, state reason for not If studying through ADM,
Last First Middle Gender Age Date of birth Certificate? Present address disability? type of If YES, specify ECCD facility studying? school
(YES/NO) present (YES/NO) (YES/NO) Services? attainment3 (YES/NO) school studying specify type of ADM year?
address disability2 (YES/NO) (YES/NO)

TALINIO SAMANTHA MAE A F 5 5/1/2013

FERRER EUNICE F F 6 5/19/2012

DE VERA MICHAELLA F F 6 11/30/2011 CK

TALINIO NICOLE JED F F 7 2/25/2011

SALINAS FRANZ CYRUS V M 9 9/12/2008

ANGULUAN LARRY, JR. M 9 4/15/2009

DE VERA EMERALD F F 10 2/11/2008

FERRER LEVY F M 11 1/25/2007

TALINIO ZEUS A M 12 8/21/2005

SALINAS JEZARIE CYRIL V F 13 7/16/2004

DE VERA EMERSON F M 13 8/24/2004

DE VERA JESLEE S 13 9/25/2004

ASK: "Is the child a permanent resident?" (YES/NO) If YES, follow up "do the residents plan on moving out?"
1

2
TYPES OF DISABILITIES: (see DepED Order No. 2, s 2014 for detailed descriptions) INTERVIEWER NAME AND SIGNATURE
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:
3
21-May-18
CK- Completed Kindergarten C7- Completed Grade 7 SK- Some Kindergarten S7- Some Grade 7 DATE OF INTERVIEWS
C1- Completed Grade 1 C8- Completed Grade 8 S1- Some Grade 1 S8- Some Grade 8
C2- Completed Grade 2 C9- Completed Grade 9 S2- Some Grade 2 S9- Some Grade 9
C3- Completed Grade 3 C10- Completed Grade 10 S3- Some Grade 3 S10- Some Grade 10
C4- Completed Grade 4 C11- Completed Grade 11 S4- Some Grade 4 S11- Some Grade 11
C5- Completed Grade 5 C12- Completed Grade 12 S5- Some Grade 5 S12- Some Grade 12
C6- Completed Grade 6 S6- Some Grade 6

NAME DEMOGRAPHIC INFORMATION RESIDENCE DISABILITY ECCD (FOR 4YO CHILDREN) EDUCATIONAL STATUS

Number of Is residence If YES, Provided Planning to

With Birth years in Has a specify with ECCD Educational Currently If YES, specify name of If NO, state reason for not If studying through ADM, study next
Last First Middle Gender Age Date of birth Certificate? Present address disability? studying? school
present permanent? If YES, specify ECCD facility
1

(YES/NO) (YES/NO) type of Services? attainment3 (YES/NO) school studying specify type of ADM year?
address (YES/NO) disability2 (YES/NO) (YES/NO)

DE VERA SHANELL LOREIGN C F 6 12/3/2011

NAVARRO KATELYN R F 7 6/3/2011

FERNANDEZ PRINCESS LAUREN D F 7 11/17/2010

TALINO NATHANIEL A M 7 10/13/2010 CK

DE VERA R-JAY L M 8 5/9/2010

DE VERA ALEXANDER RENZ T M 8 2/12/2010

DE VERA LUSHAINNA L F 8 6/28/2010

FERNANDEZ PRINCESS TANYA D F 8 6/13/2009

DE VERA ASHLEY REIL T F 9 11/22/2008

DE VERA JOS JILLIAN L M 9 7/4/2008

NAVARRO ARJAY R M 10 11/21/2007

CASACLANG KYLE B M 12 1/4/2006

ASK: "Is the child a permanent resident?" (YES/NO) If YES, follow up "do the residents plan on moving out?"
1

2
TYPES OF DISABILITIES: (see DepED Order No. 2, s 2014 for detailed descriptions) INTERVIEWER NAME AND SIGNATURE
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

3
EDUCATIONAL ATTAINMENT: 21-May-18
CK- Completed Kindergarten C7- Completed Grade 7 SK- Some Kindergarten S7- Some Grade 7 DATE OF INTERVIEWS
C1- Completed Grade 1 C8- Completed Grade 8 S1- Some Grade 1 S8- Some Grade 8
C2- Completed Grade 2 C9- Completed Grade 9 S2- Some Grade 2 S9- Some Grade 9
C3- Completed Grade 3 C10- Completed Grade 10 S3- Some Grade 3 S10- Some Grade 10
C4- Completed Grade 4 C11- Completed Grade 11 S4- Some Grade 4 S11- Some Grade 11
C5- Completed Grade 5 C12- Completed Grade 12 S5- Some Grade 5 S12- Some Grade 12
C6- Completed Grade 6 S6- Some Grade 6

NAME DEMOGRAPHIC INFORMATION RESIDENCE DISABILITY ECCD (FOR 4YO CHILDREN) EDUCATIONAL STATUS

Number of If YES, Provided Planning to

With Birth years in Is residence Has a specify with ECCD Educational Currently If YES, specify name of If NO, state reason for not If studying through ADM, study next
Last First Middle Gender Age Date of birth Certificate? Present address present permanent?
1
disability? type of Services? If YES, specify ECCD facility attainment3 studying? school studying specify type of ADM school
(YES/NO) address (YES/NO) (YES/NO) disability2 (YES/NO) (YES/NO) year?
(YES/NO)

DE VERA VICE ADRIAN H M 4 7/14/2013 YES 4 YES

MAGALONG JURT STEVEN R M 5 1/17/2013 YES 5 YES YES

MAGALONG NATHAN JAY R M 7 11/4/2010 YES 7 YES C1 YES

NEVADO MHATTEO A M 8 3/13/2011 YES 8 YES C1 YES

NEVADO MELVIN A M 9 10/2/2009 YES 9 YES C3 YES

DE VERA VANESSA C F 10 8/26/2007 YES 10 YES C5 YES

DE VERA CHRIS NICOL C F 11 5/7/2007

DE VERA MICHAEL CHRIS H M 11 2/13/2007 YES 11 YES C5 YES

NEVADO KREA ANN A F 12 11/19/2005 YES 12 YES C6 YES

MAGALONG KEVIN A M 12 11/2/2005 YES 12 YES C6 YES

DE VERA BERNALYN C F 12 8/16/2005 YES 12 YES C6 YES

DE VERA JENNIFER H F 13 3/4/2005 YES 13 YES C7 YES

ASK: "Is the child a permanent resident?" (YES/NO) If YES, follow up "do the residents plan on moving out?"
1

2
TYPES OF DISABILITIES: (see DepED Order No. 2, s 2014 for detailed descriptions) INTERVIEWER NAME AND SIGNATURE
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

3
EDUCATIONAL ATTAINMENT: 21-May-18
CK- Completed Kindergarten C7- Completed Grade 7 SK- Some Kindergarten S7- Some Grade 7 DATE OF INTERVIEWS
C1- Completed Grade 1 C8- Completed Grade 8 S1- Some Grade 1 S8- Some Grade 8
C2- Completed Grade 2 C9- Completed Grade 9 S2- Some Grade 2 S9- Some Grade 9
C3- Completed Grade 3 C10- Completed Grade 10 S3- Some Grade 3 S10- Some Grade 10
C4- Completed Grade 4 C11- Completed Grade 11 S4- Some Grade 4 S11- Some Grade 11
C5- Completed Grade 5 C12- Completed Grade 12 S5- Some Grade 5 S12- Some Grade 12
C6- Completed Grade 6 S6- Some Grade 6

NAME DEMOGRAPHIC INFORMATION RESIDENCE DISABILITY ECCD (FOR 4YO CHILDREN) EDUCATIONAL STATUS

Planning to
With Birth Number of Is residence Has a If YES, Provided Currently study next
Certificate? years in disability? specify with ECCD Educational studying? If YES, specify name of If NO, state reason for not If studying through ADM, school
Last First Middle Gender Age Date of birth Present address present permanent?
1
type of Services? If YES, specify ECCD facility attainment3 school studying specify type of ADM
(YES/NO) (YES/NO) (YES/NO) (YES/NO) year?
address disability2 (YES/NO) (YES/NO)

LAMBINO EXEKIEL J M 6 9/30/2011 YES MABULITEC, MALASIQUI, PANGASINAN 6 YES CK YES

QUITLONG DANIEL T M 6 2/19/2012 YES MABULITEC, MALASIQUI, PANGASINAN 6 YES CK YES

SALINAS MAXIELLE EMBER S F 8 9/30/2009 YES MABULITEC, MALASIQUI, PANGASINAN 8 YES C3 YES

RAMIREZ CRISTINA L F 9 2/16/2009 YES MABULITEC, MALASIQUI, PANGASINAN 9 YES C3 YES

CAYABYAB JOVE CELYX F M 9 5/21/2009 YES MABULITEC, MALASIQUI, PANGASINAN 9 YES C3 YES

AMADOR RYLEEN CYEN C F 9 2/22/2009 YES MABULITEC, MALASIQUI, PANGASINAN 9 YES C3 YES

QUITLONG MATTHEW T M 9 4/15/2009 YES MABULITEC, MALASIQUI, PANGASINAN 9 YES C3 YES

SALINAS MAXCINNE AYESHA S F 10 5/2/2008 YES MABULITEC, MALASIQUI, PANGASINAN 10 YES C4 YES

DELA CRUZ CARL CEDRICK S M 11 11/26/2006 YES MABULITEC, MALASIQUI, PANGASINAN 11 YES C5 YES

CAYABYAB JUAN CARLO F M 12 6/16/2005 YES MABULITEC, MALASIQUI, PANGASINAN 12 YES C7 YES

SALINAS MAXCIV VINCENT S M 12 9/12/2003 YES MABULITEC, MALASIQUI, PANGASINAN 12 YES C8 YES

QUITLONG NIKKO T M 12 2/21/2006 YES MABULITEC, MALASIQUI, PANGASINAN 12 YES C6 YES

ASK: "Is the child a permanent resident?" (YES/NO) If YES, follow up "do the residents plan on moving out?"
1
2
TYPES OF DISABILITIES: (see DepED Order No. 2, s 2014 for detailed descriptions) INTERVIEWER NAME AND SIGNATURE
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

3
EDUCATIONAL ATTAINMENT: 21-May-18
CK- Completed Kindergarten C7- Completed Grade 7 SK- Some Kindergarten S7- Some Grade 7 DATE OF INTERVIEWS
C1- Completed Grade 1 C8- Completed Grade 8 S1- Some Grade 1 S8- Some Grade 8
C2- Completed Grade 2 C9- Completed Grade 9 S2- Some Grade 2 S9- Some Grade 9
C3- Completed Grade 3 C10- Completed Grade 10 S3- Some Grade 3 S10- Some Grade 10
C4- Completed Grade 4 C11- Completed Grade 11 S4- Some Grade 4 S11- Some Grade 11
C5- Completed Grade 5 C12- Completed Grade 12 S5- Some Grade 5 S12- Some Grade 12
C6- Completed Grade 6 S6- Some Grade 6

NAME DEMOGRAPHIC INFORMATION RESIDENCE DISABILITY ECCD (FOR 4YO CHILDREN) EDUCATIONAL STATUS

If YES, Planning to
With Birth Number of Is residence Has a Provided Currently study next
years in specify with ECCD Educational If YES, specify name of If NO, state reason for not If studying through ADM,
Last First Middle Gender Age Date of birth Certificate? Present address present permanent?
1
disability? type of Services? If YES, specify ECCD facility studying? school studying specify type of ADM school
(YES/NO) (YES/NO) (YES/NO) attainment3 (YES/NO) year?
address disability2 (YES/NO)
(YES/NO)

DELA CRUZ MARY ROSE S F 4 8/11/2013 YES MABULITEC, MALASIQUI, PANGASINAN 4 YES YES

SALINAS MAC JAMES M M 4 10/2/2013 YES MABULITEC, MALASIQUI, PANGASINAN 4 YES

BOQUIREN SANDARA F 4 8/29/2014 YES MABULITEC, MALASIQUI, PANGASINAN 4 YES YES

SALINAS ANGELYN M F 6 1/23/2012 YES MABULITEC, MALASIQUI, PANGASINAN 6 YES CK YES

DELA CRUZ JIMMYRICK S M 7 12/28/2010 YES MABULITEC, MALASIQUI, PANGASINAN 7 YES CK YES

BOQUIREN SARAH JANE F 7 10/9/2011 YES MABULITEC, MALASIQUI, PANGASINAN 7 YES C2 YES

DELA CRUZ ERIKA JANE S F 9 5/5/2009 YES MABULITEC, MALASIQUI, PANGASINAN 9 YES C3 YES

BOQUIREN DANIELA L M 9 6/11/2008 YES MABULITEC, MALASIQUI, PANGASINAN 9 YES C4 YES

SALINAS MARJORIE B F 10 2/2/2008 YES MABULITEC, MALASIQUI, PANGASINAN 10 YES C4 YES

FANO SHAIRA B F 10 10/3/2008 YES MABULITEC, MALASIQUI, PANGASINAN 10 YES C4 YES

BOQUIREN DANIELA L F 10 6/4/2007 YES MABULITEC, MALASIQUI, PANGASINAN 10 YES C5 YES

SALINAS JOMARIE B M 13 4/11/2005 YES MABULITEC, MALASIQUI, PANGASINAN 13 YES C6 YES

ASK: "Is the child a permanent resident?" (YES/NO) If YES, follow up "do the residents plan on moving out?"
1

2
TYPES OF DISABILITIES: (see DepED Order No. 2, s 2014 for detailed descriptions) INTERVIEWER NAME AND SIGNATURE
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

3
EDUCATIONAL ATTAINMENT: 21-May-18
CK- Completed Kindergarten C7- Completed Grade 7 SK- Some Kindergarten S7- Some Grade 7 DATE OF INTERVIEWS
C1- Completed Grade 1 C8- Completed Grade 8 S1- Some Grade 1 S8- Some Grade 8
C2- Completed Grade 2 C9- Completed Grade 9 S2- Some Grade 2 S9- Some Grade 9
C3- Completed Grade 3 C10- Completed Grade 10 S3- Some Grade 3 S10- Some Grade 10
C4- Completed Grade 4 C11- Completed Grade 11 S4- Some Grade 4 S11- Some Grade 11
C5- Completed Grade 5 C12- Completed Grade 12 S5- Some Grade 5 S12- Some Grade 12
C6- Completed Grade 6 S6- Some Grade 6

NAME DEMOGRAPHIC INFORMATION RESIDENCE DISABILITY ECCD (FOR 4YO CHILDREN) EDUCATIONAL STATUS

Planning to
With Birth Number of Is residence Has a If YES, Provided Currently study next
Last First Middle Gender Age Date of birth Certificate? Present address years in permanent?1 disability? specify with ECCD If YES, specify ECCD facility Educational studying? If YES, specify name of If NO, state reason for not If studying through ADM, school
present type of Services? attainment3 school studying specify type of ADM
(YES/NO) address (YES/NO) (YES/NO) (YES/NO) (YES/NO) year?
disability 2
(YES/NO)

BOQUIREN ANDREA L F 4 1/17/2014 YES MABULITEC, MALASIQUI, PANGASINAN 4 YES

LAMBINO JEM-VER M M 5 3/31/2013 YES

ARMAS JONA MAE P F 7 7/2/2011 YES MABULITEC, MALASIQUI, PANGASINAN 7 YES

BOQUIREN ANGELO L M 8 5/22/2010 YES MABULITEC, MALASIQUI, PANGASINAN 8 YES C2 YES

ARMAS ARBY P M 8 11/10/2010 YES MABULITEC, MALASIQUI, PANGASINAN 8 YES C2 YES

LAMBINO JERWIN M M 8 1/5/2010 YES MABULITEC, MALASIQUI, PANGASINAN 8 YES C2 YES

LAMBINO GRACE ANN M F 9 11/5/2008 YES MABULITEC, MALASIQUI, PANGASINAN 9 YES C4 YES

TAMAYO ZIANA A F 10 8/24/2007 YES MABULITEC, MALASIQUI, PANGASINAN 10 YES C5 YES

ARMAS NICOLE P F 10 9/4/2007 YES MABULITEC, MALASIQUI, PANGASINAN 10 YES C5 YES

DE VERA GC L M 10 1/1/2008 YES MABULITEC, MALASIQUI, PANGASINAN 10 YES C4 YES

LAMBINO MARCO M M 11 5/31/2007 YES MABULITEC, MALASIQUI, PANGASINAN 11 YES C5 YES

ARMAS ALEXA JOY P F 12 9/12/2004 YES MABULITEC, MALASIQUI, PANGASINAN 12 YES C4 YES

ASK: "Is the child a permanent resident?" (YES/NO) If YES, follow up "do the residents plan on moving out?"
1

2
TYPES OF DISABILITIES: (see DepED Order No. 2, s 2014 for detailed descriptions) INTERVIEWER NAME AND SIGNATURE
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

3
EDUCATIONAL ATTAINMENT: 21-May-18
CK- Completed Kindergarten C7- Completed Grade 7 SK- Some Kindergarten S7- Some Grade 7 DATE OF INTERVIEWS
C1- Completed Grade 1 C8- Completed Grade 8 S1- Some Grade 1 S8- Some Grade 8
C2- Completed Grade 2 C9- Completed Grade 9 S2- Some Grade 2 S9- Some Grade 9
C3- Completed Grade 3 C10- Completed Grade 10 S3- Some Grade 3 S10- Some Grade 10
C4- Completed Grade 4 C11- Completed Grade 11 S4- Some Grade 4 S11- Some Grade 11
C5- Completed Grade 5 C12- Completed Grade 12 S5- Some Grade 5 S12- Some Grade 12
C6- Completed Grade 6 S6- Some Grade 6

NAME DEMOGRAPHIC INFORMATION RESIDENCE DISABILITY ECCD (FOR 4YO CHILDREN) EDUCATIONAL STATUS

Number of Is residence If YES, Provided Planning to

With Birth Has a Currently study next
Certificate? years in disability? specify with ECCD Educational studying? If YES, specify name of If NO, state reason for not If studying through ADM, school
Last First Middle Gender Age Date of birth Present address present permanent?
1
type of Services? If YES, specify ECCD facility attainment3 school studying specify type of ADM
(YES/NO) (YES/NO) (YES/NO) (YES/NO) year?
address disability2 (YES/NO) (YES/NO)

LAMBINO JOEMAR D M 4 5/8/2014 MABULITEC, MALASIQUI, PANGASINAN 4 YES

LAMBINO JACOB ANGELO C M 4 11/1/2013 MABULITEC, MALASIQUI, PANGASINAN 4 YES

MACARAEG CHRISTIAN KURT D M 6 10/29/2011 MABULITEC, MALASIQUI, PANGASINAN 6 YES CK YES

BOQUIREN GEMBERT D M 8 12/22/2009 MABULITEC, MALASIQUI, PANGASINAN 9 YES C2 YES

MACARAEG KRISTEL ANN D F 8 4/17/2010 MABULITEC, MALASIQUI, PANGASINAN 8 YES C2 YES

LAMBINO JAMES CARL C M 9 6/4/2008 MABULITEC, MALASIQUI, PANGASINAN 9 YES C4 YES

FERRER BRIAN JAMES N M 9 12/30/2008 MABULITEC, MALASIQUI, PANGASINAN 9 YES C4 YES

TAMAYO DAN MARK A M 10 12/2/2007 MABULITEC, MALASIQUI, PANGASINAN 10 YES C4 YES

LAMBINO JAY MARK C M 11 9/9/2006 MABULITEC, MALASIQUI, PANGASINAN 11 YES C6 YES

LAMBINO JAMAICA D F 12 1/12/2007 MABULITEC, MALASIQUI, PANGASINAN 12 YES C6 YES

LAGUINDAB KING JUWARD MYK Z M 13 5/2/2005 MABULITEC, MALASIQUI, PANGASINAN 13 YES C7 YES

TAMAYO DATUIN, JR A M 13 1/18/2005 MABULITEC, MALASIQUI, PANGASINAN 13 YES C6 YES

ASK: "Is the child a permanent resident?" (YES/NO) If YES, follow up "do the residents plan on moving out?"
1

2
TYPES OF DISABILITIES: (see DepED Order No. 2, s 2014 for detailed descriptions) INTERVIEWER NAME AND SIGNATURE
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

3
EDUCATIONAL ATTAINMENT: 21-May-18
CK- Completed Kindergarten C7- Completed Grade 7 SK- Some Kindergarten S7- Some Grade 7 DATE OF INTERVIEWS
C1- Completed Grade 1 C8- Completed Grade 8 S1- Some Grade 1 S8- Some Grade 8
C2- Completed Grade 2 C9- Completed Grade 9 S2- Some Grade 2 S9- Some Grade 9
C3- Completed Grade 3 C10- Completed Grade 10 S3- Some Grade 3 S10- Some Grade 10
C4- Completed Grade 4 C11- Completed Grade 11 S4- Some Grade 4 S11- Some Grade 11
C5- Completed Grade 5 C12- Completed Grade 12 S5- Some Grade 5 S12- Some Grade 12
C6- Completed Grade 6 S6- Some Grade 6

NAME DEMOGRAPHIC INFORMATION RESIDENCE DISABILITY ECCD (FOR 4YO CHILDREN) EDUCATIONAL STATUS

Number of Is residence If YES, Provided Planning to

With Birth years in Has a specify with ECCD Educational Currently If YES, specify name of If NO, state reason for not If studying through ADM, study next
Last First Middle Gender Age Date of birth Certificate? Present address disability? studying? school
present permanent? If YES, specify ECCD facility
1

(YES/NO) (YES/NO) type of Services? attainment3 (YES/NO) school studying specify type of ADM year?
address (YES/NO) disability2 (YES/NO) (YES/NO)

MACARANAS JACKIELYN D F 4 5/8/2014 MABULITEC, MALASIQUI, PANGASINAN 4 YES

VENTURA GEMALYN B F 4 3/3/2014 MABULITEC, MALASIQUI, PANGASINAN 4 YES

NAVEROS RENZLY D M 5 7/8/2012 MABULITEC, MALASIQUI, PANGASINAN 5 YES CK YES

VENTURA ALTHEA B F 7 5/24/2010 MABULITEC, MALASIQUI, PANGASINAN 7 YES C2 YES

SALINAS JEROME Q M 9 C4 YES

VENTURA MICHAELAH B F 10 12/13/2007 MABULITEC, MALASIQUI, PANGASINAN 10 YES C4 YES

SALINAS JOHN MICHAEL Q M 12 C6 YES

VENTURA DARILYN B F 12 11/13/2005 MABULITEC, MALASIQUI, PANGASINAN 12 YES C6 YES

MACARANAS JUSTINE D M 13 4/28/2005 MABULITEC, MALASIQUI, PANGASINAN 13 YES C7 YES

BOQUIREN CHARLENE E F 13 12/11/2003 MABULITEC, MALASIQUI, PANGASINAN 13 YES C8 YES

SALINAS CRISTINE

SALINAS CRISTINA

ASK: "Is the child a permanent resident?" (YES/NO) If YES, follow up "do the residents plan on moving out?"
1

2
TYPES OF DISABILITIES: (see DepED Order No. 2, s 2014 for detailed descriptions) INTERVIEWER NAME AND SIGNATURE
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

3
EDUCATIONAL ATTAINMENT: 21-May-18
CK- Completed Kindergarten C7- Completed Grade 7 SK- Some Kindergarten S7- Some Grade 7 DATE OF INTERVIEWS
C1- Completed Grade 1 C8- Completed Grade 8 S1- Some Grade 1 S8- Some Grade 8
C2- Completed Grade 2 C9- Completed Grade 9 S2- Some Grade 2 S9- Some Grade 9
C3- Completed Grade 3 C10- Completed Grade 10 S3- Some Grade 3 S10- Some Grade 10
C4- Completed Grade 4 C11- Completed Grade 11 S4- Some Grade 4 S11- Some Grade 11
C5- Completed Grade 5 C12- Completed Grade 12 S5- Some Grade 5 S12- Some Grade 12
C6- Completed Grade 6 S6- Some Grade 6

NAME DEMOGRAPHIC INFORMATION RESIDENCE DISABILITY ECCD (FOR 4YO CHILDREN) EDUCATIONAL STATUS

Number of Is residence If YES, Provided Planning to

With Birth years in Has a specify with ECCD Educational Currently If YES, specify name of If NO, state reason for not If studying through ADM, study next
Last First Middle Gender Age Date of birth Certificate? Present address disability? studying? school
present permanent? If YES, specify ECCD facility
1

(YES/NO) (YES/NO) type of Services? attainment3 (YES/NO) school studying specify type of ADM year?
address (YES/NO) disability2 (YES/NO) (YES/NO)

DE VERA GIAN LEE A M 6 10/12/2011 MABULITEC, MALASIQUI, PANGASINAN 6 YES CK YES

BOQUIREN RENALYN B F 13 1/21/2005 MABULITEC, MALASIQUI, PANGASINAN 13 YES C6 YES

ASK: "Is the child a permanent resident?" (YES/NO) If YES, follow up "do the residents plan on moving out?"
1

2
TYPES OF DISABILITIES: (see DepED Order No. 2, s 2014 for detailed descriptions) INTERVIEWER NAME AND SIGNATURE
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

3
EDUCATIONAL ATTAINMENT: 21-May-18
CK- Completed Kindergarten C7- Completed Grade 7 SK- Some Kindergarten S7- Some Grade 7 DATE OF INTERVIEWS
C1- Completed Grade 1 C8- Completed Grade 8 S1- Some Grade 1 S8- Some Grade 8
C2- Completed Grade 2 C9- Completed Grade 9 S2- Some Grade 2 S9- Some Grade 9
C3- Completed Grade 3 C10- Completed Grade 10 S3- Some Grade 3 S10- Some Grade 10
C4- Completed Grade 4 C11- Completed Grade 11 S4- Some Grade 4 S11- Some Grade 11
C5- Completed Grade 5 C12- Completed Grade 12 S5- Some Grade 5 S12- Some Grade 12
C6- Completed Grade 6 S6- Some Grade 6
 ANNEX 1B Child Mapping Tool

ILDREN

FUTURE ENROLLMENT

If YES, specify the name of prospective If NO, state reason for not planning
school to study next school year

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

INTERVIEWER NAME AND SIGNATURE

21-May-18
DATE OF INTERVIEWS
 FUTURE ENROLLMENT

If YES, specify the name of prospective If NO, state reason for not planning
school to study next school year

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL/BFF

MABULITEC INTEGRATED SCHOOL

INTERVIEWER NAME AND SIGNATURE

21-May-18
DATE OF INTERVIEWS
 FUTURE ENROLLMENT

If YES, specify the name of prospective If NO, state reason for not planning
school to study next school year

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

INTERVIEWER NAME AND SIGNATURE

21-May-18
DATE OF INTERVIEWS
 FUTURE ENROLLMENT

If YES, specify the name of prospective If NO, state reason for not planning
school to study next school year

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

INTERVIEWER NAME AND SIGNATURE

21-May-18
DATE OF INTERVIEWS
 FUTURE ENROLLMENT

If YES, specify the name of prospective If NO, state reason for not planning
school to study next school year

MABULITEC INTEGRATED SCHOOL

APAYA ELEMENTARY SCHOOL

MALASIQUI CATHOLIC SCHOOL

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

APAYA ELEMENTARY SCHOOL

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

INTERVIEWER NAME AND SIGNATURE

21-May-18
DATE OF INTERVIEWS
 FUTURE ENROLLMENT

If YES, specify the name of prospective If NO, state reason for not planning
school to study next school year

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

MALASIQUI CATHOLIC SCHOOL

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

INTERVIEWER NAME AND SIGNATURE

21-May-18
DATE OF INTERVIEWS
 FUTURE ENROLLMENT

If YES, specify the name of prospective If NO, state reason for not planning
school to study next school year

MALASIQUI CATHOLIC SCHOOL

MABULITEC INTEGRATED SCHOOL

INTERVIEWER NAME AND SIGNATURE

21-May-18
DATE OF INTERVIEWS
 FUTURE ENROLLMENT

If YES, specify the name of prospective If NO, state reason for not planning
school to study next school year

INTERVIEWER NAME AND SIGNATURE

21-May-18
 DATE OF INTERVIEWS

FUTURE ENROLLMENT

If YES, specify the name of prospective If NO, state reason for not planning
school to study next school year

INTERVIEWER NAME AND SIGNATURE

 21-May-18
DATE OF INTERVIEWS

FUTURE ENROLLMENT

If YES, specify the name of prospective If NO, state reason for not planning
school to study next school year

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

INTERVIEWER NAME AND SIGNATURE

 21-May-18
DATE OF INTERVIEWS

FUTURE ENROLLMENT

If YES, specify the name of prospective If NO, state reason for not planning
school to study next school year

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

MALASIQUI CATHOLIC SCHOOL

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

MALASIQUI CATHOLIC SCHOOL

MABULITEC INTEGRATED SCHOOL

MALASIQUI CATHOLIC SCHOOL

MABULITEC INTEGRATED SCHOOL

MALASIQUI CATHOLIC SCHOOL

MALASIQUI CATHOLIC SCHOOL

MABULITEC INTEGRATED SCHOOL

INTERVIEWER NAME AND SIGNATURE

21-May-18
DATE OF INTERVIEWS

FUTURE ENROLLMENT

If YES, specify the name of prospective If NO, state reason for not planning
school to study next school year

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

 MABULITEC INTEGRATED SCHOOL

INTERVIEWER NAME AND SIGNATURE

21-May-18
DATE OF INTERVIEWS

FUTURE ENROLLMENT

If YES, specify the name of prospective If NO, state reason for not planning
school to study next school year

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

 MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

INTERVIEWER NAME AND SIGNATURE

21-May-18
DATE OF INTERVIEWS

FUTURE ENROLLMENT

If YES, specify the name of prospective If NO, state reason for not planning
school to study next school year

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

 MABULITEC INTEGRATED SCHOOL

AGNO VALLEY COLLEGE

MABULITEC INTEGRATED SCHOOL

INTERVIEWER NAME AND SIGNATURE

21-May-18
DATE OF INTERVIEWS

FUTURE ENROLLMENT

If YES, specify the name of prospective If NO, state reason for not planning
school to study next school year

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

 MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

INTERVIEWER NAME AND SIGNATURE

21-May-18
DATE OF INTERVIEWS

FUTURE ENROLLMENT

If YES, specify the name of prospective If NO, state reason for not planning
school to study next school year

MABULITEC INTEGRATED SCHOOL

MABULITEC INTEGRATED SCHOOL

INTERVIEWER NAME AND SIGNATURE

21-May-18
DATE OF INTERVIEWS