B.

STUDENT INFORMATION
B1. LAST NAME :Caral
B2. FIRST NAME :Rizza Mae
B3. MIDDLE NAME :Dialogo
B4. EXTENSION NAME e.g. Jr., III (if applicable) :
B5. DATE OF BIRTH (Month/Day/Year) : January 27,2006
B6. AGE : 14 
B7. SEX :Female
B8. MOTHER TONGUE :Cebuano
B9. RELIGION : Roman Catholic

ADDRESS
B10. House Number and Street :
B11. Subdivision/Village/Zone :Inghoy
B12. Barangay :Valencia
B13. City/Municipality :Alegria
B14. Province :Cebu
B15. Region : VII

C. PARENT/GUARDIAN INFORMATION
FATHER
C1. Full Name (last name, first name, middle name) :Caral,Vivencio Letegio
C2. Highest Educational Attainment :Grade 6
C3. Employment Status :Laborer
C4. Working from home due to community quarantine? : NO
C5. Contact number/s (cellphone/telephone) :NA
C6. Is your family a beneficiary of 4Ps? : YES

MOTHER
C7. Full Name (last name, first name, middle name) :Caral,Helen Dialogo
C8. Highest Educational Attainment :Grade 2
C9. Employment Status :Housewife
C10. Working from home due to community quarantine? : NO
C11. Contact number/s (cellphone/telephone) :09192206387

GUARDIAN
C12. Full Name (last name, first name, middle name) :Caral, Vivencio Letegio 
C13. Highest Educational Attainment :Grade 6
C14. Employment Status :Laborer
C15. Working from home due to community quarantine? : NO
C16. Contact number/s (cellphone/telephone) :

D. HOUSEHOLD CAPACITY AND ACCESS TO DISTANCE LEARNING

D1. How does your child go to school? (Write the letter/s only) Choose all that
Applies 
A. walking 
B. public Commute 
C. family owned vehicle 
D. school service
YOUR ANSWER :B
D2. How many household members (including the enrolee) are studying in
School Year 2020-2021? Please Specify Each.
Kinder:
Grade 1:
Grade 2:
Grade 3:1
Grade 4:
Grade 5:
Grade 6:
Grade 7:1
Grade 8:
Grade 9:1
Grade 10:
Grade 11:
Grade 12:
D3. What other devices are available at home the leaner can use for learning?
(Write the letter/s only) Choose all that Applies
A. Cable TV
B. Non-Cable
C. Basic Cellphone
D. Smartphone
E. Tablet 
F. Radio
G. Desktop computer
H. laptop
I. none
J. others
YOUR ANSWER:I

D4. Do you have a way to connect to the internet? : YES 

D5. How do you connect to the internet? (Write the letter/s only) Choose all
that Applies
a. Own mobile date
b. Own broadband internet (DSL, wireless fiber, satellite)
c. Computer Shop
YOUR ANSWER:A
D6. What distance learning modalities do you prefer for your child? (Write the
letter/s only) Choose all that Applies
a. Online learning
b. Television
c. Radio
d. Modular learning
e. Combination of face to face with other modalities
f. Others
YOUR ANSWER:E
D7. What are the challenges that may affect your child’s learning process
through distance education? (Write the letter/s only) Choose all that Applies
a. Lack of available gadgets/equipments
b. Insufficient load/data allowance
c. Unstable mobile/internet connection
d. Existing health condition/s
e. Conflict with other activities (i.e. house chores)
f. No or lack of available space for studying 
g. Distractions (i.e. social media, noise from community /neighbor)
YOUR ANSWER:A,B,C,F,G