Instruction

1. Only 1 answer is required, just select one (1) applicable combination if more than 1 conditions is appropriate.
2. The total column must be equalled with the number of respondents per grade level (validation apply).
3. Total column per grade level must not exceed to 5000.

C2. Father / Mother / Guard

HEA1 HEA2 HEA3

TEACHER GRADE LEVEL MALE FEMALE TOTAL No Formal No Formal Elementary
Schooling Schooling Level

JHS

9 ICT 0

9 ACP 0
nditions is appropriate.
alidation apply).

C18. Conditional Cash Tran

C2. Father / Mother / Guardian Highest Educational Attainment
Beneficiary
HEA4 HEA5 HEA6 HEA7
Elementary High School High School After High School Education or
Graduate Level Level Graduate Vocational
(Tech/Voc/College/Post Grad) TOTAL YES

0
C18. Conditional Cash Transfer (4Ps) D2. No. of Learner/s in a household (including the enrollee) studying in
Beneficiary 2022
TOTAL

NO 1 2 3 4 5

0
uding the enrollee) studying in School Year 2021 -
D3. Household members tha
2022
TOTAL HM1 HM2 HM3 HM4

Parent/Guardian,
6 7 Parent/Guardian Parent/Guardian and
Parent/Guardian,
Siblings, Grand
Siblings & Grand
Only Siblings Parent & Other
Parent
members of family

0
D3. Household members that can provide instructional support to the child’s distance learning

HM5 HM6 HM7 HM8 HM9 HM10 HM11 HM12 HM13 HM14

Grand
Parent/Guardian, Grand
Siblings, Grand Parent,
Siblings, Grand Siblings & Parent & Other members of Other
Siblings Parent, Other Grand Other Other members
Parent, Other Grand Other family and Other (tutor/helper)
Only members of family Parent Only members of of family only
members of family Parent members (tutor/helper) only
& Others family &
& Others of family
Others
ning D4. Devices available at home that the learner c

HM15 HM16 TOTAL DA1 DA2 DA3 DA4 DA5 DA6

Television,
Learner able to do Television,
Television and Cellphone, Cellphone &
independent None Television Only Cellphone & Cellphone Only
Cellphone Radio & Radio
learning Radio
Desktop/laptop

0
at home that the learner can use for learning D6. W

DA7 DA8 DA9 DA10 DA11 TOTAL IC1 IC2 IC3

Cellphone,
Radio & Desktop/laptop
Radio & Radio Only None
Desktop/laptop only
Desktop/laptop
Mobile data,
Mobile data & broadband &
Mobile data only broadband computer shop

0
 D6. Way to connect to Internet

IC4 IC5 IC6 IC7 IC8 IC9 IC10 TOTAL DLM1

Online learning
Mobile data, only
broadband, Broadband, No internet
computer shop & computer shop & Computer shop Computer shop Other places available in the
other places Broadband only other places only and other places only area

0
 D7. Type of distance learning modality/ies prefer for the learner

DLM2 DLM3 DLM4 DLM5 DLM6 DLM7 DLM8 DLM9 DLM10

Online learning,
Online learning, Television, radio
Online learning television, radio Television & Radio & Modular Modular
television & Television Only & modular Radio only
& television & modular radio Learning Learning Only
radio learning
learning
er

DLM11 TOTAL CH1 CH2 CH3 CH4

Blended lack of available gadgets/ Lack of available gadgets/

lack of available equipment , insufficient equipment , insufficient load/
lack of available gadgets/ equipment & load/ data allowance & data allowance, unstable
gadgets/ insufficient load/ data unstable mobile/ internet mobile/ internet connection &
equipment only allowance connection existing health condition/s

0
 lack of available gadgets/
equipment , insufficient
load/ data allowance,
unstable mobile/ internet
CH5 CH6 CH7 connection, CH8existing CH9 CH10
lack of available gadgets/ lack of available gadgets/ health condition/s,
equipment , insufficient equipment , insufficient load/ difficulty in independent
load/ data allowance, data allowance, unstable learning, conflict with
lack of available gadgets/ unstable mobile/ internet mobile/ internet connection, other activities (i.e.,
equipment , insufficient load/ data connection, existing health existing health condition/s, house chores), high
allowance, unstable mobile/ internet condition/s, difficulty in difficulty in independent electrical consumption & insufficient load/
connection, existing health independent learning & learning, conflict with other distractions (i.e., social insufficient data allowance &
condition/s & difficulty in independent conflict with other activities activities (i.e., house chores) & media, noise from load/ data unstable mobile/
learning (i.e., house chores) high electrical consumption community/neighbor) allowance only internet connection
 D8. Challenges that may affect your child’s learning process thr

CH11 CH12 CH13 CH14

insufficient load/ data allowance, CH15 CH16
unstable mobile/ internet
connection, existing health
insufficient load/ data condition/s, difficulty in
allowance, unstable insufficient load/ data allowance, independent learning, conflict
insufficient load/ data mobile/ internet unstable mobile/ internet connection, with other activities (i.e., house unstable unstable mobile/
allowance, unstable connection, existing existing health condition/s, difficulty chores), high electrical mobile/ internet
mobile/ internet health condition/s & in independent learning & conflict consumption & distractions (i.e., internet connection &
connection & existing difficulty in independent with other activities (i.e., house social media, noise from connection existing health
health condition/s learning chores) community/neighbor) only condition/s
ur child’s learning process through distance education

CH17 CH18 CH19 CH20 CH21 CH22

unstable mobile/ internet
connection, existing health
condition/s, difficulty in
unstable mobile/ internet independent learning, conflict existing health existing health condition/s,
connection, existing health with other activities (i.e., condition/s, difficulty in difficulty in independent
unstable mobile/ internet condition/s, difficulty in house chores), high electrical existing independent learning & learning, conflict with other
connection, existing health independent learning & consumption & distractions health conflict with other activities (i.e., house
condition/s & difficulty in conflict with other activities (i.e., social media, noise from condition/s activities (i.e., house chores) & high electrical
independent learning (i.e., house chores) community/neighbor) only chores) consumption
 difficulty in
independent
CH23 CH24 CH25 CH26 CH27
learning, conflict CH28 CH29
with other activities
existing health condition/s, (i.e., house chores),
difficulty in independent high electrical
learning, conflict with other difficulty in consumption &
activities (i.e., house independent learning, distractions (i.e.,
chores), high electrical difficulty in independent conflict with other social media, noise conflict with other
consumption & distractions difficulty in learning & conflict with activities (i.e., house from activities (i.e.,
(i.e., social media, noise independent other activities (i.e., chores) & high community/neighbor house chores)
from community/neighbor) learning only house chores) electrical consumption ) only
 E. Are you willing to allow your child to participa
select the major
CH30
conflict with other CH31 CH32 CH33 TOTAL NO
activities (i.e.,
house chores), MC1 Fear of MC2 Limited or no
high electrical Getting Infected of available transportation
high electrical only distractions (i.e.,
consumption & Corona Virus from home to school and
consumption & social media, noise YES
distractions (i.e., vice versa
distractions (i.e., social from
social media, media, noise from community/neighbor)
noise from high electrical community/neighbor) only
community/neighb consumption
or) only

0
your child to participate in limited face to face classes? If not, please
select the major consideration
NO
MC3 MC4 Helping in MC5 Helping in MC6 Presence MC7 Other
Existing Illness household family business of Arm Conflict Reason, if any
or health related chores or working in the area
concens
TOTAL