DepEd Quick Count Survey

Deadline of Submission: 26 August 2021 (Thursday), 12:00NN

To the Class Adviser:

Please fill [__] with the number corresponding to the responses of your respective learners.
- Registration Office
Gender
[__] Male
[__] Female

Father / Mother / Guardian Highest Educational Attainment (The one who is mostly helping the
learner in answering the Learning Packets)
[__] No Formal Schooling
[__] No Formal Schooling but able to read and write
[__] Elementary Level
[__] Elementary Graduate
[__] High School Level
[__] High School Level Graduate
[__] After High School Education or Vocational (Tech/Voc/College/Post Grad)
[__] Cannot be contacted

Conditional Cash Transfer (4Ps) Beneficiary

[__] Yes
[__] No
[__] Cannot be contacted

No. of Learner/s in a household (including the enrollee) studying in School Year 2021 – 2022
[__] 1 [__] 3 [__] 5 [__] 7 or more
[__] 2 [__] 4 [__] 6 [__] Cannot be contacted

Household members that can provide instructional support to the child’s distance learning
[__] Parent/Guardian Only
[__] Parent/Guardian and Siblings
[__] Siblings Only
[__] Other members of family only
[__] Other (tutor/helper) only
[__] Learner able to do independent learning
[__] None
[__] Cannot be contacted

Devices available at home that the learner can use for learning
[__] Cellphone Only
[__] Desktop/laptop only
[__] Cellphone & Desktop/laptop
[__] None
[__] Cannot be contacted
Way to connect to Internet
[__] Mobile data only
[__] Mobile data & broadband/wifi
[__] Broadband/wifi only
[__] No internet available in the area
[__] Cannot be contacted

Type of distance learning modality/ies prefer for the learner

[__] Modular Learning (Printed)
[__] Modular Learning (Digital)
[__] Blended
[__] Cannot be contacted

Challenges that may affect your child’s learning process through distance education
[__] lack of available gadgets/ equipment , insufficient load/ data allowance & 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)
[__] Cannot be contacted

Are you willing to allow your child to participate in limited face to face classes? If not, please select
the major consideration
[__] Yes
[__] No, Fear of Getting Infected of Corona Virus
[__] No, Limited or no available transportation from home to school and vice versa
[__] No, Existing Illness or health related concens
[__] No, Helping in household chores
[__] No, Helping in family business or working
[__] Cannot be contacted