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  • Grade: - Male: - Female

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    Clarissa Cudal Reboredo
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    This document appears to be a survey collecting information about students, their families, living situations, access to technology and the internet, preferences for distance learning, and challenges to learning remotely. It requests details about the student's grade and gender. Highest levels of education for parents/guardians. Whether the student's family receives government assistance. The number of other students living in the household. Technology devices available at home. How the student connects to the internet. Preferred distance learning modalities. Potential challenges to remote learning. Willingness to participate in limited in-person classes and reasons why.

    Original Description:

    For Enrolment Focals

    Original Title

    TEMPLATE FOR QUICK COUNT

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    This document appears to be a survey collecting information about students, their families, living situations, access to technology and the internet, preferences for distance learning, and challenges to learning remotely. It requests details about the student's grade and gender. Highest levels of education for parents/guardians. Whether the student's family receives government assistance. The number of other students living in the household. Technology devices available at home. How the student connects to the internet. Preferred distance learning modalities. Potential challenges to remote learning. Willingness to participate in limited in-person classes and reasons why.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
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    8 views2 pages

    Grade: - Male: - Female

    Uploaded by

    Clarissa Cudal Reboredo
    This document appears to be a survey collecting information about students, their families, living situations, access to technology and the internet, preferences for distance learning, and challenges to learning remotely. It requests details about the student's grade and gender. Highest levels of education for parents/guardians. Whether the student's family receives government assistance. The number of other students living in the household. Technology devices available at home. How the student connects to the internet. Preferred distance learning modalities. Potential challenges to remote learning. Willingness to participate in limited in-person classes and reasons why.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 2

    Grade : ______ Male: ___ Female: ______

    C2. 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): ____________

    C10. Conditional Cash Transfer (4Ps) Beneficiary: ______

    D1. No. of Learner/s in a household (including the enrollee) studying in School Year 2021 – 2022
    HM1: Parent/Guardian Only : _________________
    HM2 Parent/Guardian and Siblings: __________
    HM3 Parent/Guardian, Siblings & Grand Parent ___________
    HM4 Parent/Guardian, Siblings, Grand Parent & Other members of family __________
    HM5 Parent/Guardian, Siblings, Grand Parent, Other members of family & Others ______
    HM6 Siblings Only _______
    HM7 Siblings & Grand Parent _______
    HM8 Siblings, Grand Parent, Other members of family & Others ______
    HM9 Grand Parent Only _______
    HM10 Grand Parent & Other members of family _________
    HM11 Grand Parent, Other members of family & Others _______
    HM12 Other members of family only ________
    HM13 Other members of family and Other (tutor/helper) _______
    HM14 Other (tutor/helper) only _________
    HM15 Learner able to do independent learning ________
    HM 16 None _____________

    D3. Devices available at home that the learner can use for learning
    DA1 Television Only ________ DA8 Radio Only ________
    DA2 Television and Cellphone _______ DA9 Radio & Desktop/laptop ______
    DA3 Television, Cellphone & Radio _______ DA10 Desktop/laptop
    only________
    DA4 Television, Cellphone, Radio & Desktop/laptop ______ DA11 Cellphone & Desktop/laptop__
    DA5 Cellphone Only ________ DA12 Tablet _____
    DA6 Cellphone & Radio _______ DA13 None ______
    DA7 Cellphone, Radio & Desktop/laptop_________

    D5. Way to connect to Internet

    IC1Mobile data only______ IC6Broadband, computer shop & other places___


    IC2Mobile data & broadband______ IC7Computer shop only______
    IC3Mobile data, broadband & computer shop____ IC8Computer shop and other places______
    IC4Mobile data, broadband, computer shop & other places____ IC9 Other places only_____
    IC5Broadband only____ IC10 No internet available in the area____

    D6. Type of distance learning modality/ies prefer for the learner

    DLM1Online learning only________ DLM7 Television, radio & modular


    learning________
    DLM2Online learning & television________ DLM8 Radio only________
    DLM3Online learning, television & radio________ DLM9 Radio & Modular Learning________
    DLM4Online learning, television, radio & modular learning________ DLM10 Modular Learning (Printed)
    ________
    DLM5 Television Only________ DLM11 Modular Learning (Digital) ________
    DLM6 Television & radio________ DLM12 Blended________
    D7. Challenges that may affect your child’s learning process through distance education

    CH1 lack of available gadgets/ equipment only


    CH2 insufficient load/ data allowance
    CH3 unstable mobile/ internet connection
    CH4 existing health condition/s
    CH5 difficulty in independent learning
    CH6 conflict with other activities
    CH7 high electrical consumption
    CH8 distractions
    CH9 OTHERS

    E. Are you willing to allow your child to participate in limited face to face classes? If not, please select the major
    consideration

    MC1Fear of Getting Infected of Corona Virus ________


    MC2Limited or no available transportation from home to school and vice versa ______
    MC3Existing Illness or health related concens _____
    MC4Helping in household chores_______
    MC5 Helping in family business or working ______
    MC6 Presence of Arm Conflict in the area_______
    MC7 Other Reason, if any_________

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