GRADE: 4

SECTION ABC
GENDER
Male
Female
Father / Mother / Guardian Highest Educational Attainment
HEA1 No Formal Schooling
HEA2 No Formal Schooling but able to read and write
HEA3 Elementary Level
HEA4 Elementary Graduate
HEA5 High School Level
HEA6 High School Level Graduate
HEA7 After High School Education or Vocational
(Tech/Voc/College/Post Grad)
Conditional Cash Transfer (4Ps) Beneficiary
YES
NO
No. of Learner/s in a household (including the enrollee) studying in School Year 2021
- 2022.
1
2
3
4
5
6
7
Household members that can provide instructional support to the child’s distance
learning
HEA1 Parent/Guardian Only
HEA2 Parent/Guardian and Siblings
HEA3 Parent/Guardian, Siblings & Grand Parent
HEA4 Parent/Guardian, Siblings, Grand Parent & Other members of
family
HEA5 Parent/Guardian, Siblings, Grand Parent, Other members of family
& Others
HEA6 Siblings Only
HEA7 Siblings & Grand Parent
HEA8 Siblings, Grand Parent, Other members of family & Others
HEA9 Grand Parent Only
HEA10 Grand Parent & Other members of family
HEA11 Grand Parent, Other members of family & Others
HEA12 Other members of family only
HEA13 Other members of family and Other (tutor/helper)
HEA14 Other (tutor/helper) only
HEA15 Learner able to do independent learning
 HEA16 None
Devices available at home that the learner can use for learning
DA1 Television Only
DA2 Television and Cellphone
DA3 Television, Cellphone & Radio
DA4 Television, Cellphone, Radio & Desktop/laptop
DA5 Cellphone Only
DA6 Cellphone & Radio
DA7 Cellphone, Radio & Desktop/laptop
DA8 Radio Only
DA9 Radio & Desktop/laptop
DA10 Desktop/laptop only
DA11 None
Way to connect to Internet
IC1 Mobile data only
IC2 Mobile data & broadband
IC3 Mobile data, broadband & computer shop
IC4 Mobile data, broadband, computer shop & other places
IC5 Broadband only
IC6 Broadband, computer shop & other places
IC7 Computer shop only
IC8 Computer shop and other places
IC9 Other places only
IC10 No internet available in the area
Type of distance learning modality/ies prefer for the learner
DLM1 Online learning only
DLM2 Online learning & television
DLM3 Online learning, television & radio
DLM4 Online learning, television, radio & modular learning
DLM5 Television Only
DLM6 Television & radio
DLM7 Television, radio & modular learning
DLM8 Radio only
DLM9 Radio & Modular Learning
DLM10 Modular Learning Only
Challenges that may affect your child’s learning process through distance education
CH1 lack of available gadgets/ equipment only
CH2 lack of available gadgets/ equipment & insufficient load/ data
allowance
CH3 lack of available gadgets/ equipment , insufficient load/ data
allowance & unstable mobile/ internet connection
CH4 lack of available gadgets/ equipment , insufficient load/ data
allowance, unstable mobile/ internet connection & existing health
condition/s
CH5 lack of available gadgets/ equipment , insufficient load/ data
allowance, unstable mobile/ internet connection, existing health
condition/s & difficulty in independent learning
CH6 lack of available gadgets/ equipment , insufficient load/ data
allowance, unstable mobile/ internet connection, existing health
condition/s, difficulty in independent learning & conflict with other
activities (i.e., house chores)
CH7 lack of available gadgets/ equipment , insufficient load/ data
allowance, unstable mobile/ internet connection, existing health
condition/s, difficulty in independent learning, conflict with other
activities (i.e., house chores) & high electrical consumption
CH8 lack of available gadgets/ equipment , insufficient load/ data
allowance, unstable mobile/ internet connection, existing health
condition/s, difficulty in independent learning, conflict with other
activities (i.e., house chores), high electrical consumption &
distractions (i.e., social media, noise from community/neighbor)
CH9 insufficient load/ data allowance only
CH10 insufficient load/ data allowance & unstable mobile/ internet
connection
CH11 insufficient load/ data allowance, unstable mobile/ internet
connection & existing health condition/s
CH12 insufficient load/ data allowance, unstable mobile/ internet
connection, existing health condition/s & difficulty in independent
learning
CH13 insufficient load/ data allowance, unstable mobile/ internet
connection, existing health condition/s, difficulty in independent
learning & conflict with other activities (i.e., house chores)
CH14 insufficient load/ data allowance, unstable mobile/ internet
connection, existing health condition/s, difficulty in independent
learning, conflict with other activities (i.e., house chores), high
electrical consumption & distractions (i.e., social media, noise
from community/neighbor)
CH15 unstable mobile/ internet connection only
CH16 unstable mobile/ internet connection & existing health condition/s
CH17 unstable mobile/ internet connection, existing health condition/s
& difficulty in independent learning
CH18 unstable mobile/ internet connection, existing health condition/s,
difficulty in independent learning & conflict with other activities
(i.e., house chores)
CH19 unstable mobile/ internet connection, existing health condition/s,
difficulty in independent learning, conflict with other activities (i.e.,
house chores), high electrical consumption & distractions (i.e.,
social media, noise from community/neighbor)
CH20 existing health condition/s only
CH21 existing health condition/s, difficulty in independent learning &
conflict with other activities (i.e., house chores)
CH22 existing health condition/s, difficulty in independent learning,
conflict with other activities (i.e., house chores) & high electrical
consumption
CH23 existing health condition/s, difficulty in independent learning,
conflict with other activities (i.e., house chores), high electrical
consumption & distractions (i.e., social media, noise from
community/neighbor)
CH24 difficulty in independent learning only
 CH25 difficulty in independent learning & conflict with other activities
(i.e., house chores)
CH26 difficulty in independent learning, conflict with other activities (i.e.,
house chores) & high electrical consumption
CH27 difficulty in independent learning, conflict with other activities (i.e.,
house chores), high electrical consumption & distractions (i.e.,
social media, noise from community/neighbor)
CH28 conflict with other activities (i.e., house chores) only
CH29 conflict with other activities (i.e., house chores), & high electrical
consumption
CH30 conflict with other activities (i.e., house chores), high electrical
consumption & distractions (i.e., social media, noise from
community/neighbor)
CH31 high electrical consumption only
CH32 high electrical consumption & distractions (i.e., social media,
noise from community/neighbor)
CH33 only distractions (i.e., social media, noise from
community/neighbor) only
Are you willing to allow your child to participate in limited face to face classes? If not,
please select the major consideration
YES
MC1 Fear of Getting Infected of Corona Virus
MC2 Limited or no available transportation from home to school and
vice versa
MC3 Existing Illness or health related concens
MC4 Helping in household chores
MC5 Helping in family business or working
MC6 Presence of Arm Conflict in the area
MC7 Other Reason, if any
TOTAL 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
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3 1 1 1
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21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40