ENROLLMENT

GRADE MALE FEMALE TOTAL

LEVEL
12 - STEM I
STEM II
STEM III
STEM IV
TOTAL
12 – HUMSS I
HUMSS II
HUMSS III
HUMSS IV
HUMSS V
HUMSS VI
TOTAL
12 – BAP I
BAP II
BAP III
TOTAL
SMAW I
SMAW II
SMAW III
TOTAL
TAILORING
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 / Guardian Highest Educational Attainment

Grade Level HEA 1 HEA 2 HEA 3 HEA 4 HEA 5 HEA 6 HEA 7 Total

Grade 7 0 0 0 0 0 0 0 0

Grade 8 0 0 0 0 0 0 0 0

Grade 9 0 0 0 0 0 0 0 0

Grade 10 0 0 0 0 0 0 0 0

Grade 11 0 0 0 0 0 0 0 0

Grade 12 0 0 0 0 0 0 0 0
 Non-graded 0 0 0 0 0 0 0 0

Legend:

HEA 1 No Formal Schooling HEA 5 High School Level

HEA 2 No Formal Schooling but able to read and write HEA 6 High School Level Graduate

HEA 3 Elementary Level HEA 7 After High School Education or Vocational (Tech/Voc/College/Post Grad)

HEA 4 Elementary Graduate

C10. Conditional Cash Transfer (4Ps) Beneficiary

Grade Level Yes No Total

Grade 7 0 0 0

Grade 8 0 0 0

Grade 9 0 0 0
 Grade 10 0 0 0

Grade 11 0 0 0

Grade 12 0 0 0

Non-graded 0 0 0

D1. No. of Learner/s in a household (including the enrollee) studying in School Year 2021 - 2022

Grade Level 1 2 3 4 5 6 7 Total

Grade 7 0 0 0 0 0 0 0 0

Grade 8 0 0 0 0 0 0 0 0

Grade 9 0 0 0 0 0 0 0 0
 Grade 10 0 0 0 0 0 0 0 0

Grade 11 0 0 0 0 0 0 0 0

Grade 12 0 0 0 0 0 0 0 0

Non-graded 0 0 0 0 0 0 0 0

D2. Household members that can provide instructional support to the child’s distance learning

Gra HM1 HM 2 HM
3 HM 4 HM
5 HM 6 HM
7 HM 8 HM 9 HM 10 HM 11 HM 12 HM 13 HM 14 HM 15 HM 16 To
de tal
Lev
el

Gra 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
de 7

Gra 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
de 8
 Gra 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
de 9

Gra 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
de
10

Gra 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
de
11

Gra 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
de
12

Non 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
-
grad
ed

Legend:

HM 1 Parent/Guardian Only HM 9 Grand Parent Only

HM 2 Parent/Guardian and Siblings HM 10 Grand Parent & Other members of family

HM3 Parent/Guardian, Siblings & Grand Parent HM11 Grand Parent, Other members of family & Others
 HM4 Parent/Guardian, Siblings, Grand Parent & Other members of family HM12 Other members of family only

HM5 Parent/Guardian, Siblings, Grand Parent, Other members of family & Others HM13 Other members of family and Other (tutor/helper)

HM6 Siblings Only HM14 Other (tutor/helper) only

HM7 Siblings & Grand Parent HM15 Learner able to do independent learning

HM8 Siblings, Grand Parent, Other members of family & Others HM16 None

D3. Devices available at home that the learner can use for learning

Gra DA 1 DA 2 DA 3 DA 4 DA 5 DA 6 DA 7 DA 8 DA 9 DA 10 DA 11 DA 12 DA 13 To
de tal
Lev
el

Gra 0 0 0 0 0 0 0 0 0 0 0 0 0 0
de 7

Gra 0 0 0 0 0 0 0 0 0 0 0 0 0 0
de 8

Gra 0 0 0 0 0 0 0 0 0 0 0 0 0 0
de 9
 Gra 0 0 0 0 0 0 0 0 0 0 0 0 0 0
de
10

Gra 0 0 0 0 0 0 0 0 0 0 0 0 0 0
de
11

Gra 0 0 0 0 0 0 0 0 0 0 0 0 0 0
de
12

Non 0 0 0 0 0 0 0 0 0 0 0 0 0 0
-
grad
ed

Legend:

DA 1 Television Only DA 8 Radio Only

DA 2 Television and Cellphone DA 9 Radio & Desktop/laptop

DA 3 Television, Cellphone & Radio DA 10 Desktop/laptop only

DA 4 Television, Cellphone, Radio & Desktop/laptop DA 11 Cellphone & Desktop/laptop

DA 5 Cellphone Only DA 12 Tablet

 DA 6 Cellphone & Radio DA 13 None

DA 7 Cellphone, Radio & Desktop/laptop

D5. Way to connect to Internet

Grad IC 1 IC 2 IC 3 IC 4 IC 5 IC 6 IC 7 IC 8 IC 9 IC 10 Tot
e al
Level

Grad 0 0 0 0 0 0 0 0 0 0 0
e7

Grad 0 0 0 0 0 0 0 0 0 0 0
e8

Grad 0 0 0 0 0 0 0 0 0 0 0
e9

Grad 0 0 0 0 0 0 0 0 0 0 0
e 10

Grad 0 0 0 0 0 0 0 0 0 0 0
e 11
 Grad 0 0 0 0 0 0 0 0 0 0 0
e 12

Non- 0 0 0 0 0 0 0 0 0 0 0
grade
d

Legend:

IC 1 Mobile data only IC 6 Broadband, computer shop & other places

IC 2 Mobile data & broadband IC 7 Computer shop only

IC 3 Mobile data, broadband & computer shop IC 8 Computer shop and other places

IC 4 Mobile data, broadband, computer shop & other places IC 9 Other places only

IC 5 Broadband only IC 10 No internet available in the area

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

Gra DLM 1 DLM 2 DLM 3 DLM 4 DLM 5 DLM 6 DLM 7 DLM 8 DLM 9 DLM 10 DLM 11 DLM 12 Tot
de al
Lev
el
 Gra 0 0 0 0 0 0 0 0 0 0 0 0 0
de 7

Gra 0 0 0 0 0 0 0 0 0 0 0 0 0
de 8

Gra 0 0 0 0 0 0 0 0 0 0 0 0 0
de 9

Gra 0 0 0 0 0 0 0 0 0 0 0 0 0
de
10

Gra 0 0 0 0 0 0 0 0 0 0 0 0 0
de
11

Gra 0 0 0 0 0 0 0 0 0 0 0 0 0
de
12

Non 0 0 0 0 0 0 0 0 0 0 0 0 0
-
grad
ed

Legend:
 DLM 1 Online learning only DLM 7 Television, radio & modular learning

DLM 2 Online learning & television DLM 8 Radio only

DLM 3 Online learning, television & radio DLM 9 Radio & Modular Learning

DLM 4 Online learning, television, radio & modular learning DLM 10 Modular Learning (Printed)

DLM 5 Television Only DLM 11 Modular Learning (Digital)

DLM 6 Television & radio DLM 12 Blended

D7. Challenges that may affect your child’s learning process through distance education

G CH CH CH CH CH CH CH CH CH CH CH CH CH CH CH CH CH CH CH CH CH CH CH CH CH CH CH CH CH CH CH CH CH T
r 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33
o
a t
d a
e l
L
e
v
e
l

G 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
r
a
d
e
7

G 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
r
a
d
e
8

G 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
r
a
d
e
9

G 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
r
a
d
e
1
0

G 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
r
a
d
e
1
1
 G 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
r
a
d
e
1
2

N 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
o
n
-
g
r
a
d
e
d

Legend:

CH 1 lack of available gadgets/ equipment only CH

18 unstable mobile/ internet connection, existing health condition/s,
difficulty in independent learning & conflict with other activities
(i.e., house chores)

CH 2 lack of available gadgets/ equipment & insufficient load/ data allowance CH

19 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)

CH 3 lack of available gadgets/ equipment , insufficient load/ data allowance & unstable CH
20 existing health condition/s only
 mobile/ internet connection

CH
4 lack of available gadgets/ equipment , insufficient load/ data allowance, unstable CH
21 existing health condition/s, difficulty in independent learning &
mobile/ internet connection & existing health condition/s conflict with other activities (i.e., house chores)

CH
5 lack of available gadgets/ equipment , insufficient load/ data allowance, unstable CH
22 existing health condition/s, difficulty in independent learning,
mobile/ internet connection, existing health condition/s & difficulty in independent conflict with other activities (i.e., house chores) & high electrical
learning consumption

CH
6 lack of available gadgets/ equipment , insufficient load/ data allowance, unstable CH
23 existing health condition/s, difficulty in independent learning,
mobile/ internet connection, existing health condition/s, difficulty in independent conflict with other activities (i.e., house chores), high electrical
learning & conflict with other activities (i.e., house chores) consumption & distractions (i.e., social media, noise from
community/neighbor)

CH
7 lack of available gadgets/ equipment , insufficient load/ data allowance, unstable CH
24 difficulty in independent learning only
mobile/ internet connection, existing health condition/s, difficulty in independent
learning, conflict with other activities (i.e., house chores) & high electrical
consumption

CH
8 lack of available gadgets/ equipment , insufficient load/ data allowance, unstable CH
25 difficulty in independent learning & conflict with other activities
mobile/ internet connection, existing health condition/s, difficulty in independent (i.e., house chores)
learning, conflict with other activities (i.e., house chores), high electrical
consumption & distractions (i.e., social media, noise from community/neighbor)

CH
9 insufficient load/ data allowance only CH
26 difficulty in independent learning, conflict with other activities (i.e.,
house chores) & high electrical consumption

CH
10 insufficient load/ data allowance & unstable mobile/ internet connection CH
27 difficulty in independent learning, conflict with other activities (i.e.,
house chores), high electrical consumption & distractions (i.e.,
 social media, noise from community/neighbor)

CH 11 insufficient load/ data allowance, unstable mobile/ internet connection & existing CH 28 conflict with other activities (i.e., house chores) only
health condition/s

CH 12 insufficient load/ data allowance, unstable mobile/ internet connection, existing CH 29 conflict with other activities (i.e., house chores), & high electrical
health condition/s & difficulty in independent learning consumption

CH 13 insufficient load/ data allowance, unstable mobile/ internet connection, existing CH 30 conflict with other activities (i.e., house chores), high electrical
health condition/s, difficulty in independent learning & conflict with other activities consumption & distractions (i.e., social media, noise from
(i.e., house chores) community/neighbor)

CH 14 insufficient load/ data allowance, unstable mobile/ internet connection, existing CH 31 high electrical consumption only
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)

CH 15 unstable mobile/ internet connection only CH 32 high electrical consumption & distractions (i.e., social media, noise
from community/neighbor)

CH 16 unstable mobile/ internet connection & existing health condition/s CH 33 only distractions (i.e., social media, noise from
community/neighbor) only

CH 17 unstable mobile/ internet connection, existing health condition/s & difficulty in

independent learning

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

Grade Level Yes No Total

 MC 1 MC 2 MC 3 MC 4 MC 5 MC 6 MC 7

Grade 7 0 0 0 0 0 0 0 0 0

Grade 8 0 0 0 0 0 0 0 0 0

Grade 9 0 0 0 0 0 0 0 0 0

Grade 10 0 0 0 0 0 0 0 0 0

Grade 11 0 0 0 0 0 0 0 0 0

Grade 12 0 0 0 0 0 0 0 0 0

Non-graded 0 0 0 0 0 0 0 0 0
Legend:

MC 1 Fear of Getting Infected of Corona Virus MC 5 Helping in family business or working

MC 2 Limited or no available transportation from home to school and vice versa MC 6 Presence of Arm Conflict in the area

MC 3 Existing Illness or health related concens MC 7 Other Reason, if any

MC 4 Helping in household chores

Sa ve