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(This form can be used to tabulate survey result of Class/Section, Grade and School lev
NAME OF SCHOOL SAN AGUSTIN INTEGRATED SCHOOL
Grade/School Level 9 *Section ST. JAMES
Last updated (date): For LIS Adm
Date Posted in LIS QC
B9. Gender
Total (Must be
equalled vis-à-vis
Grade Level Male Female
Enrollment per
Class/Grade Level)
9 17 11 28
C2. Parent/Guardian Highest Educational Attainment (select only parent/guardian per learner ha
No Formal Schooling
No Formal Elementary
but able to read and Elementary level
Grade Level Schooling write
Graduate
D1. How many of your household members (including the enrollee) are studying in School Year
Only 1
2 Household 3 Household 4 Household
Grade Level Household
Members Members Members
Member
8 6 4 4
D2. Who among the household members can provide instructional support to the child’s distan
Parent/ Guardian,
Parent/ Parent/ Guardian,
Parent/ Guardian Siblings, Grand
Guardian Siblings & Grand
Grade Level and Siblings Parent & Other
Only Parent
members of family
Grade Level
D3. What devices are available at home that the learner can use for learning?
Television,
Television Television and Television, Cellphone
Cellphone, Radio
Grade Level Only Cellphone & Radio
& Desktop/laptop
Total (Must be
equalled vis-à-vis
Grade Level Yes No
Enrollment per
Class/Grade Level)
9 13 10 23
Mobile data,
Mobile data,
Mobile data Mobile data & broadband,
broadband & computer
Grade Level only broadband computer shop &
shop
other places
D6. What distance learning modality/ies do you prefer for your child?
online online learning,
online learning & online learning,
learning television, radio &
Grade Level television television & radio
only modular learning
DLM1 DLM2 DLM3 DLM4
9 3
D7. What are the challenges that may affect your child’s learning process through distance edu
lack of available
gadgets/
lack of available
lack of equipment ,
lack of available gadgets/ equipment ,
available insufficient load/
gadgets/ equipment insufficient load/ data
gadgets/ data allowance,
Grade Level equipment & insufficient load/ allowance & unstable unstable mobile/
data allowance mobile/ internet
only internet connection
connection
& existing health
condition/s
E2. If the answer is no , please select only 1 major consideration or state specific reason
Fear of Limited or no
Getting available Existing Illness or Helping in
Infected of transportation from health related concens household chores
Grade Level
Corona home to school and
Virus vice versa
MC1 MC2 MC3 MC4
9 18
1 23
Parent/ Guardian,
Siblings, Grand Siblings, Grand Parent,
Parent, Other Siblings Only Siblings & Grand Parent Other members of family
members of & Others
family & Others
HM5 HM6 HM7 HM8
1
broadband,
Computer shop and
Broadband only computer shop & Computer shop only
other places
other places
ur child/children to participate?
ecific reason
helping in family
Presence of Arm Total (Must be equalled
business or Other Reason, if any
Conflict in the area with no. of "No"
working
responses from E1)
MC5 MC6 MC7
5 23
ck for accuracy/completeness
ll Grade Levels
ol Head for review and approval and then to LIS System Administrator
IC9 IC10
1 18
Total (Must be
equalled vis-à-vis
Enrollment per
Class/Grade Level)
23
insufficient load/ data
allowance, unstable
insufficient load/ data
mobile/ internet
allowance, unstable
connection, existing unstable
mobile/ internet
health condition/s, mobile/
connection, existing
difficulty in independent unstable mobile/ internet
health condition/s,
learning, conflict with internet connection connection &
difficulty in
other activities (i.e., only existing
independent learning
house chores), high health
& conflict with other
electrical consumption & condition/s
activities (i.e., house
distractions (i.e., social
chores)
media, noise from
community/neighbor)
30
unstable mobile/
internet connection,
unstable mobile/
existing health
internet connection,
condition/s, difficulty in
unstable mobile/ existing health
independent learning, existing
internet connection, condition/s,
conflict with other health
existing health difficulty in
activities (i.e., house condition/s
condition/s & difficulty independent
chores), high electrical only
in independent learning learning & conflict
consumption &
with other activities
distractions (i.e., social
(i.e., house chores)
media, noise from
community/neighbor)
CH32 CH33
26