(Sample Questionnaire for Student Beneficiaries)

Name :_________________________ Grade Level :_________________

Age :_________________________ Height :____cm. Weight: ____kg.
Gender: ________________________ Body Mass Index (BMI) : __________
Address : _______________________ BMI Classification : _______________
________________________________

1. What type of family do you belong?

a. Single Parent Family (Consists either mother or father and children)
b. Nuclear Family (Consists of two parents and children)
c. Extended Family (Consists of many relatives living together)
d. Step Family (Consists of two separate families merging into one new unit)
e. Grandparent Family (Consist of grandparents raising the children alone)
Others (please specify) : __________________________________________

2. Total number of your siblings: ______________________________________

3. What is the occupation of your parents?

a. Father : ______________________ b. Mother : _________________________________

4. What is the status of occupation of your parents?

4.1 Father
a. Contractual c. On-Call
b. Regular Others, Please specify : _____________
4.2 Mother
c. Contractual c. On-Call
d. Regular Others, Please specify : _____________

5. How much is the combined monthly income of your parents?

a. P 5,000.00-P10,000.00 c. P15,001.00-P20,000.00
b. P 10,001.00-P15,000.00 d. P20,001.00-P25,000.00
Others, please specify : _______________________________________

6. How long does your family start receiving receiving conditional cash grants from Pantawid
Pamilyang Pilipino Program (4P’s)? Please indicate year started.
______________________________________________________________

7. Does your parent attend school programs or class meetings wherein their presence is needed?
__ Yes __ No, Why? ______________________________________________

8. Do you pay your school and classroom dues on time?

__ Yes __ No, Why? ______________________________________________