LES QUICK COUNT

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.

B9 GENDER

GRADE LEVEL MALE FEMALE Total (Must be

equalled vis-à-vis
Enrollment per
Class/Grade Level
K
1
2
3
4
5
6

C2. Father / Mother / Guardian Highest Educational Attainment

GRADE HEA1 HEA2 HEA3 HEA4 HEA5 HEA6 HEA7 TOTAL

LEVEL

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

GRADE LEVEL YES NO TOTAL

K
1
2
3
4
5
6

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

GRADE 1 2 3 4 5 6 7+ TOTAL
LEVEL
K
1
2
3
4
5
6

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

GRAD HM1 HM2 HM3 HM4 HM5 HM6 HM7 HM8 HM9 HM10 HM11 HM12 HM13
E
LEVEL
K
1
2
3
4
5
6

HM1 Parent/Guardian Only HM9 Grand Parent Only

HM2 Parent/Guardian and Siblings HM10 Grand Parent & Other members of
 family

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

HM4 Parent/Guardian, Siblings, Grand HM12 Other members of family only

Parent & Other members of family

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

HM6 Siblings Only HM14 Other (tutor/helper) only

HM7 Siblings & Grand Parent HM15 Learner able to do independent

learning

HM8 Siblings, Grand Parent, Other HM16 None

members of family & Others

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

GRADELEVE DA1 DA2 DA3 DA4 DA5 DA6 DA7 DA8 DA9 DA10 DA11 DA12 DA13
L
K
1
2
3
4
5
6

Legend:

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 & DA11 Cellphone & Desktop/laptop
Desktop/laptop

DA5 Cellphone Only DA12 Tablet

DA6 Cellphone & Radio DA13 None

DA7 Cellphone, Radio & Desktop/laptop

D5. Way to connect to Internet

GRADE IC1 IC2 IC3 IC4 IC5 IC6 IC7 IC8 IC9 IC10 TOTAL
LEVEL
K
1
2
3
4
5
6

Legend:

IC1 Mobile data only IC6 Broadband, computer shop & other
places

IC2 Mobile data & broadband IC7 Computer shop only

IC3 Mobile data, broadband & computer shop IC8 Computer shop and other places

IC4 Mobile data, broadband, computer shop & other IC9 Other places only
places

IC5 Broadband only IC10 No internet available in the area

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

GRAD DLM1 DLM DLM DLM4 DLM DLM DLM7 DLM DLM DLM10 DLM1 DLM12 TOTAL
E 2 3 5 6 8 9 1
LEVEL
K
1
2
3
4
5
6

Legend:

DLM1 Online learning only DLM7 Television, radio & modular

learning

DLM2 Online learning & television DLM8 Radio only

DLM3 Online learning, television & radio DLM9 Radio & Modular Learning

DLM4 Online learning, television, radio & modular DLM10 Modular Learning (Printed)
learning

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

GRAD CH1 CH2 CH3 CH4 CH5 CH6 CH7 CH8 CH9 CH9 CH10 CH11 CH12
E
LEVEL
K
1
2
 3
4
5
6

GRAD CH13 CH14 CH15 CH16 CH17 CH18 CH19 CH20 CH21 CH22 CH23 CH24 CH25
E
LEVEL
K
1
2
3
4
5
6

GRAD CH26 CH27 CH28 CH29 CH30 CH31 CH32 CH33 TOTAL
E
LEVEL
K
1
2
3
4
5
6

Legend:

CH1 lack of available gadgets/ equipment only CH18 unstable mobile/ internet connection,
existing health condition/s, difficulty in
independent learning & conflict with
other activities (i.e., house chores)

CH2 lack of available gadgets/ equipment & insufficient CH19 unstable mobile/ internet connection,
load/ data allowance 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)
CH3 lack of available gadgets/ equipment , insufficient
load/ data allowance & unstable mobile/ internet
connection
CH4 lack of available gadgets/ equipment , insufficient
load/ data allowance, unstable mobile/ internet
connection & existing health condition/s
CH5 lack of available gadgets/ equipment , insufficient
load/ data allowance, unstable mobile/ internet
connection, existing health condition/s & difficulty
in independent learning
CH6 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)
CH7 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
CH8 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)
CH9 insufficient load/ data allowance only
CH10 insufficient load/ data allowance & unstable mobile/
internet connection
CH20 existing health condition/s only
CH21 existing health condition/s, difficulty in
independent learning & conflict with
other activities (i.e., house chores)
CH22 existing health condition/s, difficulty in
independent learning, conflict with
other activities (i.e., house chores) &
high electrical consumption
CH23 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)
CH24 difficulty in independent learning only
CH25 difficulty in independent learning &
conflict with other activities (i.e., house
chores)
CH26 difficulty in independent learning,
conflict with other activities (i.e., house
chores) & high electrical consumption
CH27 difficulty in independent learning,
conflict with other activities (i.e., house
chores), high electrical consumption &
distractions (i.e., social media, noise
 from community/neighbor)

CH11 insufficient load/ data allowance, unstable mobile/ CH28 conflict with other activities (i.e., house
internet connection & existing health condition/s chores) only

CH12 insufficient load/ data allowance, unstable mobile/ CH29 conflict with other activities (i.e., house
internet connection, existing health condition/s & chores), & high electrical consumption
difficulty in independent learning

CH13 insufficient load/ data allowance, unstable mobile/ CH30 conflict with other activities (i.e., house
internet connection, existing health condition/s, chores), high electrical consumption &
difficulty in independent learning & conflict with distractions (i.e., social media, noise
other activities (i.e., house chores) from community/neighbor)

CH14 insufficient load/ data allowance, unstable mobile/ CH31 high electrical consumption only
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)

CH15 unstable mobile/ internet connection only CH32 high electrical consumption &
distractions (i.e., social media, noise
from community/neighbor)

CH16 unstable mobile/ internet connection & existing CH33 only distractions (i.e., social media,
health condition/s noise from community/neighbor) only

CH17 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 YES NO TOTAL

LEVEL MC1 MC2 MC3 MC4 MC5 MC6 MC7
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 MC 6 Presence of Arm Conflict in the

home to school and vice versa area

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

MC4 Helping in household chores