UNIFAST REGIONAL MONITORING AND EVALUATION TOOL

Implementation of R.A. No. 10931 “Universal Access to Quality Tertiary Education Act”

STUDENT SURVEY FORM

Republic Act No. 10931 recognizes that quality education is an inalienable right of all Filipinos, and it is therefore the policy of the State to
protect and promote the rights of all students to quality education at all levels. This monitoring and evaluation tool is created to ensure that
the State shall take appropriate steps to make quality tertiary education accessible and available to all, shall ensure the optimized utilization
of government resources in education, and shall provide adequate guidance and incentives in channeling young Filipinos in their career
choices and towards the proper development and utilization of human resources.

Essentially, this survey form shall serve to ensure compliance with the policies and guidelines of the Universal Access to Quality Tertiary
Education (UAQTE) programs, and monitor the processes and outcomes of the UniFAST in the effective delivery of services to its
stakeholders.

General Directions:
1. Kindly fill out each of the fields in this survey form as honestly and accurately as you can. Your answers will be kept strictly confidential.
2. Put a tick mark in checkboxes for selection of options. You may select multiple answers if necessary.
3. Do not leave blank entries. In case any question is not applicable to you, put N/A (Not Applicable).
4. Extra sheets may be used in answering any question, as needed.

Academic Year Covered: ___ ___ ___ ___ – ___ ___ ___ ___

PART I. DEMOGRAPHIC INFORMATION

I.A. STUDENT PROFILE

Student ID Number TES Award Number
Name (Last Name, First Name, MI) Date of Birth (MM/DD/YYYY)
Present Home Address
Permanent Home Address
Email Address Phone No. Age
⬜ Single ⬜ Married ⬜ Separated ⬜
Gender ⬜ Male ⬜ Female Civil Status
Widowed
Family Source of Income Monthly Family Income Group (upon joining UAQTE program)
⬜ Salary ⬜ Less than ₱10,957 per month ⬜ Between ₱76,699 to ₱131,484 per month
⬜ Honoraria ⬜ Between ₱10,957 to ₱21,914 per month ⬜ Between ₱131,484 to ₱219,140 per month
⬜ Interest ⬜ Between ₱21,914 to ₱43,828 per month ⬜ At least ₱219,140 per month
⬜ Commission ⬜ Between ₱43,828 to ₱76,699 per month Please indicate exact monthly family income: ₱________________
⬜ Business Family Occupational Classification (Please refer to the attachment for examples of tasks performed by each group)
⬜ Skilled Agricultural, Forestry and Fishery
⬜ Pension ⬜ Managers
Workers
⬜ Overseas Filipino
⬜ Professionals ⬜ Craft and Related Trades Workers
Remittance
⬜ Other Remittance ⬜ Technicians and Associate Professionals ⬜ Plant and Machine Operators and Assemblers
⬜ Others (Please specify) ⬜ Clerical Support Workers ⬜ Elementary Occupations
____________________________ ⬜ Service and Sales Workers ⬜ Armed Forces Operations
Birth Order ________ from a family of ________ siblings Total No. of Members of ______ Parents + ______
Living with Extended Family ⬜ Yes ⬜ No If Yes, how many? Nuclear Family Siblings

Person with Disability (PWD) ⬜ Yes ⬜ No If Yes, please specify:

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 Member of IP Community ⬜ Yes ⬜ No If Yes, please specify:

I.B. STUDY PROFILE

⬜ SUC ⬜ LUC ⬜
Name of HEI Type of HEI
Private
Complete Address
Course / Degree Program Year Level
⬜ Diploma ⬜ Degree ⬜ 2-3 Year Program
Type of Course / Degree
⬜ Board ⬜ Non-Board No. of Years of Course / ⬜ 4-Year Program
Program
Degree Program
(Please check all that apply) ⬜
⬜ Non-Certification ⬜ 5-Year Program
Certification
No. of Units Enrolled for
______ 1st Sem / Term / Qtr ______ 2nd Sem / Term / Qtr ______ Summer / 3rdTerm / Qtr ______ 4th Quarter
the Academic Year
⬜ Regular ⬜ Underload ⬜ Overload
Latest Academic Load
Cite reason/s for the underload / overload:
Student Classification ⬜ Ongoing ⬜ New
⬜ No If Yes, from what HEI? ⬜ SUC ⬜ LUC ⬜
Transferee from Other HEI ⬜ Yes
Private
Program Shiftee ⬜ Yes ⬜ No If Yes, from what previous program?
Second Courser ⬜ Yes ⬜ No If Yes, specify program name graduated:
Foreign Student ⬜ Yes ⬜ No If Yes, specify nationality:
No. of Terms of Current Degree Program No. of Completed Terms in Current Degree Program
No. of Terms as FHE Beneficiary No. of Terms as TES Grantee
HEI with Leave of Absence (LOA) Policy? ⬜ Yes ⬜ No No. of Times Availed of LOA ____ times in ____ years

PART II. PARTICIPATION IN UAQTE PROGRAMS

I am a beneficiary of ⬜ FHE Only ⬜ TES Only ⬜ Both FHE and TES ⬜ Other StuFAPs (Please specify, if
any) _________________________

II.A. FREE HIGHER EDUCATION

Please check all applicable FHE benefits awarded: Is there any other school fees being paid to the HEI? ⬜ Yes ⬜ No
⬜ Tuition fees ⬜ Development fees If Yes, please specify:

⬜ Library fees ⬜ Guidance fees

⬜ Computer fees ⬜ Handbook fees
⬜ Laboratory fees ⬜ Entrance fees Did the HEI provide an accurate computation of TOSF? ⬜ Yes ⬜ No
⬜ School ID fees ⬜ Registration fees If No, cite the reason/s:

⬜ Athletic fees ⬜ Medical and Dental fees

⬜ Admission fees ⬜ Cultural fees Means of Verification: *COR

For each of the following items, put a check mark (✔ ) on the appropriate column that corresponds to your answer.
Provision of School Activities, Facilities, and Services to Students Available Given Available and Given Means of Verification
1. Library facility and services
2. Laboratory / facility per program (e.g., computer laboratory,
kitchen, education technology room, gymnasium, speech
laboratory, science laboratory)

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 3. Computer facility
4. Medical / Dental clinic and services
5. Insurance
6. School ID
7. Student Handbook
8. Athletic activities
9. Cultural activities
10. Career Guidance and Counselling related activities
11. School admission / entrance activities
12. Student development programs, some of which, if
applicable, are given to selected groups:
a. leadership trainings;
b. off-campus experiential learning (field trips and the like);
c. student partnerships and activities of student
organizations;
d. student publication / newsletter;
e. life-long learning activities;
f. spiritual, social and values programs; and
g. bridging/remedial programs
13. Other student development programs, activities, and
projects (Please specify) _____________________________________________

II.B. TERTIARY EDUCATION SUBSIDY

Please choose the TES prioritization category you belong
TES benefits received: Is there any other school fees being paid to the HEI? ⬜ Yes ⬜ No
to:
⬜ ESGP-PA ⬜ New Listahanan ⬜ TES-1 If Yes, please specify:

⬜ 4Ps SWDI ⬜ New PNSL ⬜ TES-2

⬜ Ongoing Listahanan ⬜ TES-3A
⬜ Ongoing PNSL ⬜ TES-3B
Other programs under TES:
⬜ TDP

II.B.1 TES for Private HEIs

1. Have you signed a TES Sharing Agreement with the HEI? ⬜ Yes ⬜ No If No, cite the reason/s:

Means of Verification: *Copy of TES Sharing Agreement

2. Did the HEI provide an accurate computation of TOSF ⬜ Yes ⬜ No If No, cite the reason/s:
and stipend?

Means of Verification: *COR and payroll of covered academic year

3. Did the HEI collect any other fee from your TES grant ⬜ Yes ⬜ No If Yes, please specify and attach proof:
other than the TOSF?

4. Did you receive your full and accurate TES grant for the ⬜ Yes ⬜ No If No, please specify amount received and attach proof:
Academic Year?

Means of Verification: *Payment receipt of covered academic year

5. Did you sign the TES payroll document for the covered ⬜ Yes ⬜ No If No, cite the reason/s:
Academic Year?

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 Means of Verification: *Payroll of covered academic year

II.B.2 TES for Public HEIs (SUCs and LUCs)

1. Did the HEI collect any fee from your TES grant for the ⬜ Yes ⬜ No If Yes, please specify and attach proof:
Academic Year?

2. Did you receive your full and accurate TES grant for the ⬜ Yes ⬜ No If No, please specify amount received and attach proof:
Academic Year?

Means of Verification: *Payment receipt of covered academic year

3. Did you sign the TES payroll document for the covered ⬜ Yes ⬜ No If No, cite the reason/s:
Academic Year?

Means of Verification: *Payroll of covered academic year

II.B.3 Other programs under TES - Tulong Dunong Program (TDP)

1. Did you receive your full and accurate TDP-TES grant for ⬜ Yes ⬜ No If No, please specify amount received and attach proof:
the Academic Year?

Means of Verification: *Payment receipt of covered academic year

2. Did you sign the TDP-TES payroll document for the ⬜ Yes ⬜ No If No, cite the reason/s:
covered Academic Year?

Means of Verification: *Payroll of covered academic year

II.C. MY UAQTE EXPERIENCE

Please rate your personal experience on (5) (4) (3) (2) (1)
Instruction:
the situations listed below. Tick (✔ ) the
Highly Satisfied Neither Satisfied Dissatisfied Highly
numerical rating that best describes
Satisfied nor Dissatisfied Dissatisfied
your experience.
1. The orientation meetings, workshops, and events conducted
by the HEI provide clear and accurate information on the
programs under UAQTE.
2. The HEI provides an office, a personnel, and a bulletin board
to address the needs of the beneficiaries under the UAQTE
programs.
3. The HEI provides efficient and accessible communication
channels for the proper dissemination of information
regarding the implementation of programs under UAQTE.
4. The HEI provides a clear mechanism or policy on how to
raise concerns and grievances on the implementation of the
programs under UAQTE.
5. The HEI provides assistance and guidance to the
beneficiaries in having the right attitude, motivation, and
behavior in pursuing the degree program.
6. The HEI provides referral assistance concerning the
psychological, social, and other welfare needs of the
beneficiaries.
7. The HEI provides financial counseling programs and other
support programs, as may be deemed necessary.

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 II.D. OBSERVATIONS AND RECOMMENDATIONS
List down or enumerate what is being asked from the following statements, and please provide a brief explanation for your answers.
1. Good Practices in the Implementation of the UAQTE Programs

2. Challenges / Concerns in the Implementation of the UAQTE Programs

3. Recommendations for the Improvement of the Implementation of the UAQTE Programs

CONSENT FORM
In submitting this survey form, I agree to my details being used for the purposes of monitoring and evaluation of the programs under
Republic Act No. 10931. The information will only be accessed by the UniFAST. I understand that my data will be held securely and will
not be distributed to third parties. I understand that when this information is no longer required for these purposes, my data will be
disposed of by the UniFAST in accordance with Republic Act No. 10173, otherwise known as the Data Privacy Act of 2012.

Signature

Date Accomplished

Examples of Tasks Performed by Each Occupational Group

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 MANAGERS
● Formulating and advising on the policy, budgets, laws and regulations of
enterprises, governments and other organizational units
● Establishing objectives and standards and formulating and evaluating
programs and policies and procedures for their implementation
● Ensuring appropriate systems and procedures are developed and
implemented to provide budgetary control
● Authorizing material, human and financial resources to implement policies
and programs
● Monitoring and evaluating performance of the organization or enterprise
and of its staff
● Selecting, or approving the selection of staff
● Ensuring compliance with health and safety requirements
● Planning and directing daily operations
● Representing and negotiating on behalf of the government, enterprise or
organizational unit managed in meetings and other forums
PROFESSIONALS
● Conducting analysis and research, and developing concepts, theories and
operational methods, and advising on or applying existing knowledge
related to physical sciences including mathematics, engineering and
technology, and to life sciences including the medical and health services,
as well as to social sciences and humanities
● Teaching the theory and practice of one or more disciplines at different
educational levels
● Teaching and educating handicapped persons
● Providing various business, legal and social services
● Creating and performing works of art
● Providing spiritual guidance
● Preparing scientific papers and reports
TECHNICIANS AND ASSOCIATE PROFESSIONALS
● Undertaking and carrying out technical work connected with research and
the application of concepts and operational methods in the fields of physical
sciences including engineering and technology, life sciences including the
medical profession, and social sciences and humanities
● Initiating and carrying out various technical services related to trade,
finance, administration, including administration of government laws and
regulations, and to social work
● Providing technical support for the arts and entertainment
● Participating in sporting activities
● Executing some religious tasks
CLERICAL SUPPORT WORKERS
● Stenography, typing, and operating word processors and other office
machines
● Entering data into computers
● Carrying out secretarial duties
● Recording and computing numerical data
● Keeping records relating to stocks, production and transport
● Keeping records relating to passenger and freight transport
● Carrying out clerical duties in libraries
● Filing documents
● Carrying out duties in connection with mail services
● Preparing and checking material for printing
● Writing on behalf of illiterate persons
● Performing money-handling operations
● Dealing with travel arrangements
● Supplying information requested by clients and making appointments
● Operating a telephone switchboard
CRAFT AND RELATED TRADES WORKERS
● Constructing, maintaining and repairing buildings and other structures
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SERVICE AND SALES WORKERS
● Organizing and providing services during travel
● Housekeeping
● Preparing and serving of food and beverages
● Caring for children
● Providing personal and basic health care at homes or in institutions, as well
as hairdressing, beauty treatment and companionship
● Telling fortunes
● Embalming and arranging funerals
● Providing security services and protecting individuals and property against
fire and unlawful acts
● Enforcing of law and order
● Posing as models for advertising, artistic creation and display of goods
● Selling goods in wholesale or retail establishments, as well as at stalls and
on markets
● Demonstrating goods to potential customers
SKILLED AGRICULTURAL, FORESTRY AND FISHERY WORKERS
● Preparing the soil
● Sowing, planting, spraying, fertilising and harvesting field crops
● Growing fruit and other tree and shrub crops
● Growing garden vegetables and horticultural products
● Gathering wild fruits and plants
● Breeding, raising, tending or hunting animals mainly to obtain meat, milk,
hair, fur, skin, sericultural, apiarian or other products
● Cultivating, conserving and exploiting forests
● Breeding or catching fish
● Cultivating or gathering other forms of aquatic life
● Storing and carrying out some basic processing of their produce
● Selling their products to purchasers, marketing organisations or at markets
PLANT AND MACHINE OPERATORS AND ASSEMBLERS
● Operating and monitoring mining or other industrial machinery and
equipment for processing metal, minerals, glass, ceramics, wood, paper, or
chemicals
● Operating and monitoring machinery and equipment used to produce
articles made of metal, minerals, chemicals, rubber, plastics, wood, paper,
textiles, fur, or leather, and which process foodstuffs and related products
● Driving and operating trains and motor vehicles
● Driving, operating and monitoring mobile industrial and agricultural
machinery and equipment
● Assembling products from component parts according to strict
specifications and procedures
ELEMENTARY OCCUPATIONS
● Cleaning, restocking supplies and performing basic maintenance in
apartments, houses, kitchens, hotels, offices and other buildings
● Washing cars and windows
● Helping in kitchens and performing simple tasks in food preparation
● Delivering messages or goods
● Carrying luggage and handling baggage and freight
● Stocking vending machines or reading and emptying meters
● Collecting and sorting refuse
● Sweeping streets and similar places
● Performing various simple farming, fishing, hunting or trapping tasks
● Performing simple tasks connected with mining, construction and
manufacturing including product-sorting
● Packing and unpacking produce by hand and filling shelves
● Providing various street services
● Pedalling or hand-guiding vehicles to transport passengers and goods
● Driving animal-drawn vehicles or machinery
ARMED FORCES OCCUPATIONS
 ● All jobs held by members of the armed fo
● Casting, welding and shaping metal ● Included are regular members of the arm
● Installing and erecting heavy metal structures, tackle and related equipment military training or other service for a spe
● Making machinery, tools, equipment, and other metal articles ● Excluded are jobs held by persons in civi
● Setting for operators, or setting and operating various machine tools issues, police (other than military police)
● Fitting, maintaining and repairing industrial machinery, including engines and vehicles, as well as electrical and
electronic instruments and other equipment
● Making precision instruments, jewellery, household and other precious-metal articles, pottery, glass and related
products
● Producing handicrafts
● Executing printing work
● Producing and processing foodstuffs and various articles made of wood, textiles, leather and related materials

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