Consolidation - Lces Sex Disaggregated Data

Republic of the Philippines
Department of Education
Region IV-A
SCHOOLS DIVISION OF QUEZON PROVINCE
APPENDIX AMA.
GENDER AND DEVELOPMENT (GAD) SURVEY INSTRUMENT
(For individual)
School: LUTGARDA CAUSAPIN ELEMENTARY SCHOOL
District SARIAYA WEST
DATA PRIVACY
Pursuant to Data Privacy Act of 2012, the Department of Education – Division of Quezon recognizes the
privacy and the security of your personal information. Please be informed, therefore, that by using this
survey instrument, we may collect and store personal information about you. Rest assured that any
information collected will be protected and will only be used for the purpose of GAD database in the
division which will serve as reference for implementing gender responsive PPAs. Should you have
further questions, the division GFPS members are ready to assist you.
INTELLECTUAL PROPERTY NOTE
This survey instrument is a property of the DepEd-Division of Quezon which is lifted on different legal
and relevant sources on gender and development. Hence, no part of this instrument may be reproduced
in whatever forms without prior written permission from the institution .
Instrument legal and relevant sources:

American Academy of Pediatrics. (2010). Stages of Adolescent Development. Retrieved from https://www.aap.org
American Psychological Association. (2012). Guidelines for Psychological Practice with Lesbian, Gay, and Bisexual
Clients. American Psychologist, 67(1), 10–42. doi: 10.1037/a0024659
American Psychological Association. (2015). Guidelines for Psychological Practice with Transgender and Gender
Nonconforming People. American Psychologist, 70(9), 832- 864. doi.org/10.1037/a0039906
CSC MC No. 40, s. 1998: Revised Omnibus Rules on Appointments and Other Personnel Actions. Retrieved from
www.csc.gov.ph
CSC MC No. 15, s. 1999: Additional Provisions and Amendments to CSC MC No. 40, s.1998. Retrieved from
www.csc.gov.ph
Department of Health. (2012). Philippine Health Advisories. Retrieved from https://www.doh.gov.ph
DepEd Order No. 77, S. 2010: Guidelines on the Allocation/Deployment of New Teaching, Teaching-Related and
Non-
DEPEDQUEZON-TM-SDS-04-025-003
“Creating Possibilities, Inspiring Innovations”

Address: Sitio Fori, Brgy. Talipan, Pagbilao, Quezon
Trunkline #: (042) 784-0366, (042) 784-0164, (042) 784-0391, (042) 784-0321
Email Address: quezon@deped.gov.ph
Website: www.depedquezon.com.ph
Region IV-A
Teaching Positions for FY 2010

Gold, M. (2018). The ABCs of L.G.B.T.Q.I.A.+. The Network Times. Retrieved from https://www.nytimes.com
Graham, M.A. (2017). Special Needs Children - Know the Types and Know Your Rights. Retrieved from
https://pbwslaw.com
LGBTQIA Resource Center. (2020). LGBTQIA Resource Center Glossary. Retrieved from
https://lgbtqia.ucdavis.edu/educated/glossary
Medley, M.L. (1980). Life satisfaction across four stages of adult life. Int J Aging Hum Dev.1980;11(3):193-209. doi:
10.2190/D4LG-ALJQ-8850-GYDV
Philippine Statistics Authority. (2017). Religious Affiliation. Retrieved from https://psa.gov.ph
Philippine Statistics Authority. (2017). Marital Status. Retrieved from https://psa.gov.ph
Philippine Statistics Authority. (2017). 2017 Philippine Standard Classification of Education. Retrieved from
https://psa.gov.ph
World Health Organization. (2020). Elder Abuse. https://www.who.int
SURVEY INSTRUMENT
General Guidelines: This survey instrument aims to institutionalize division GAD database with
adequate and systematically gathered sex-disaggregated data which will provide the bases for gender
analysis, planning, programming, and policy formulation in the division. Specifically, this instrument
contains variables that significantly contribute to your gender needs. Please accomplish this tool with
utmost honesty.
Direction: Please put a check mark (/) on the box appropriate to your response to the information
needed below.
Sex Assignment (by birth): □ Male □ Female
PERSONAL INFORMATION
1. Position
□ Teaching Related Personnel (includes the Education Program Supervisor, Principal, Asst. Principal, Head
Teacher, and Guidance Counselor/Coordinator) 1
□ Teaching Personnel (includes Master Teacher or Teacher from elementary, secondary, ALS, Madrasah, TVE,
and SPED) 15
□ Non-Teaching Personnel (includes the librarian, senior bookkeeper, disbursing officer, administrative officer
and assistant and all others do not fall under teaching related and teaching personnel) 1
2. Age
□ 18 to 21 years old

Trunkline #: (042) 784-0366, (042) 784-0164, (042) 784-0391, (042) 784-0321
Region IV-A
□ 22 to 34 years old 10
□ 65 years old and older

3. Years in Service (DepEd)
□ 0 to 5 years 6
□ 6 to 10 years 7
□ 11 to 15 years 2
□ 16 to 20 years
□ 21 to 25 years 1
□ 26 to 30 years 1
□ 31 to 35 years
□ 36 to 40 years
4. Highest Educational Attainment
□ Elementary non-graduate
□ Elementary graduate
□ Highschool non-graduate
□ High school graduate
□ Short-cycle tertiary education/ diploma holder (2 to 3 years)
□ With units in baccalaureate degree
□ Baccalaureate degree graduate 6
□ With units in post-baccalaureate degree 7
□ Post-baccalaureate degree graduate (master’s degree) 3
□ With units in doctoral degree

Trunkline #: (042) 784-0366, (042) 784-0164, (042) 784-0391, (042) 784-0321
Region IV-A
□ Doctoral degree graduate 1
□ Others
5. Monthly Income
□ Below Php 8,000.00
□ Php 8,001.00 to Php 15,000.00
□ Php 15,001.00 to Php 30,000.00 15
□ Php 30,001.00 to Php 50,000.00 1
□ Php 50,001.00 to Php 99,000.00 1
□ Php 100,000.00 and above
6. Special Needs/Conditions (reported case supported by medical document/s)

(You may select more than one when applicable)
6.1. Physical
□ Muscular
□ Dystrophy
□ Multiple Sclerosis
□ Chronic Asthma
□ Epilepsy
□ Others
□ None 17
6.2. Developmental
□ Down Syndrome
□ Autism
□ Dyslexia
□ Processing Disorder

Trunkline #: (042) 784-0366, (042) 784-0164, (042) 784-0391, (042) 784-0321
Region IV-A
□ Others
□ None 17
6.3. Behavioral/Emotional (acquire upon employment)
□ ADD
□ Bi-Polar
□ Oppositional Defiance Disorder
□ Others
□ None 17
6.4. Sensory Impaired
□ Blind
□ Visually Impaired
□ Deaf
□ Limited Hearing 1
□ Others
□None 16
7. Health Conditions (reported case supported by medical document/s)
7.1. With Infectious Disease
□ Acute Respiratory Infection
□ A (H1N1)
□ Bird Flu
□ Chickenpox
□ Cholera
□ Dengue
□ Diarrhea

Trunkline #: (042) 784-0366, (042) 784-0164, (042) 784-0391, (042) 784-0321
Region IV-A
□ Ebola Reston
□ Filariasis
□ Hepatitis (A, B, C)
□ HIV/AIDS
□ Influenza
□ Malaria
□ Measles
□ Novel Coronavirus
□ Poliomyelitis
□ Rabies
□ Severe Acute Respiratory Syndrome (SARS)
□ Sexually Transmitted Infections (STIs)
□ Tuberculosis
□ Typhoid Fever
□ Others
□ None 17
7.2. With Non-Infectious Disease
□ Alzheimer’s Disease
□ Cancer
□ Epilepsy
□ Osteoarthritis
□ Osteoporosis
□ Cerebrovascular disease (stroke)

Trunkline #: (042) 784-0366, (042) 784-0164, (042) 784-0391, (042) 784-0321
Region IV-A
□ Chronic Obstructive Pulmonary Disease (COPD)
□ Coronary Artery Disease
□ Heat Stroke
□ High Blood Pressure or Hypertension 1
□ Obesity and Overweight
□ Diabetes
□ Depressive Disorders
□ Substance Abuse: Alcohol
□ Substance Abuse: Ecstasy
□ Others
□ None 16
8. Religious Affiliation
□ Aglipay
□ Buddhist
□ Iglesia ni Cristo
□ Islam
□ Jehovah's Witness
□ Protestant
□ Seventh Day Adventist
□ Roman Catholic, including Catholic Charismatic 14
□ Others 3
□ None
9. Marital Status
□ Single 3

Trunkline #: (042) 784-0366, (042) 784-0164, (042) 784-0391, (042) 784-0321
Region IV-A
□ Married 12
□ Separated 2
□ Annulled
□ Divorced
□ Widowed
□ Common-Law/Live-in
10. Employment Status
□ Permanent (issued to a person who meets all the minimum qualification requirements of the position, including the
appropriate eligibility prescribed) 17
□ Provisional/Temporary (issued to a person who meets all the requirements of the position except the
appropriate eligibility prescribed)
□ Substitute (issued to a person when the regular incumbent of the position is temporarily unable to perform the
duties of the position)
□ Co-terminous (issued to a person whose entrance and continuity in the service is based on the trust and
confidence of the appointing authority or the head of the organizational unit where assigned; or co-existent with the
incumbent; or limited by the duration of the project; or co-existent with the period for which an agency or office was created)
□ Contractual (issued to a person who shall undertake a specific work or job for a limited period which does not
exceed one year)
□ Casual (issued only for essential and necessary services where there are not enough regular staff to meet the
demands of the service)
11. Sexual Orientation
□ Heterosexual (attracted to a person of different/opposite gender identity) 17
□ Homosexual (attracted to a person of same gender identity)
□ Bisexual (attracted to persons of two or more genders)
□ Asexual (A person who doesn’t have sexual attraction to anyone.)
□ Pansexual (attracted to people of all genders and/or do not concern gender when attracted towards someone)
□ Androsexual (A person attracted to masculine gender presentation)
□ Gynosexual (A person attracted to feminine gender presentation)
□ Others
12. Gender Identity


Trunkline #: (042) 784-0366, (042) 784-0164, (042) 784-0391, (042) 784-0321
Region IV-A
□ Cisgender (a person whose gender identity and biological sex assigned at birth matched
□ Man 1
□ Woman 16
□ Transgender (a person whose gender identity does not align or is different from the sex assigned at birth)
□ Transman (female e at birth but identifies as male)

□ Transwoman (male at birth but identifies as female)
□ Gender Fluid (may always feel like a mix of the two traditional genders)
□ Agender (a person without gender identity or doesn’t identify with a particular gender)
13. Solo parent (Refer to RA 8972)
□ Yes 2 with ID □ without ID
□ No 15
14. With reported case of abuse (supported with legal document/s)
□ Physical
□ Psychological
□ Sexual
□ Financial
□ Others
□ None 17
15. Mode of Transportation (from residence to work & vice-versa)
□ Motorcycle 2
□ Tricycle 4
□ Jeep 9
□ Van

Trunkline #: (042) 784-0366, (042) 784-0164, (042) 784-0391, (042) 784-0321
Region IV-A
□ Bus
□ Train
□ Boat
□ Others 2
□ None
16. Members of Minority People (Indigenous People)
□ Aetas
□ Agtas
□ Badjaos
□ Dumagat
□ Others
□ None 17

Trunkline #: (042) 784-0366, (042) 784-0164, (042) 784-0391, (042) 784-0321
Region IV-A
DATA CONSENT FORM
I confirm that I have read and understand the purpose of this survey instrument. I also
recognize that my participation in this survey is entirely voluntary and that I am free to
withdraw at any time during the survey without consequence.
Further, I understand that any information resulting from this survey will strictly be
treated confidential and solely be used for the stated purpose and that I may have
opportunity to ask questions anytime.
Hence, I agree to take part in this survey.
JONALYN L. TAGULINAO_____
Signature of the Subject Over Printed Name
_______February 21, 2023_____

Date Signed

Trunkline #: (042) 784-0366, (042) 784-0164, (042) 784-0391, (042) 784-0321

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Republic of the Philippines

GENDER AND DEVELOPMENT (GAD) SURVEY INSTRUMENT

School: LUTGARDA CAUSAPIN ELEMENTARY SCHOOL

District SARIAYA WEST

INTELLECTUAL PROPERTY NOTE

Instrument legal and relevant sources:

“Creating Possibilities, Inspiring Innovations”

Teaching Positions for FY 2010

Sex Assignment (by birth): □ Male □ Female

“Creating Possibilities, Inspiring Innovations”

□ 65 years old and older

“Creating Possibilities, Inspiring Innovations”

□ Doctoral degree graduate 1

□ Php 8,001.00 to Php 15,000.00

□ Php 15,001.00 to Php 30,000.00 15

□ Php 30,001.00 to Php 50,000.00 1

□ Php 50,001.00 to Php 99,000.00 1

□ Php 100,000.00 and above

6. Special Needs/Conditions (reported case supported by medical document/s)

“Creating Possibilities, Inspiring Innovations”

□ Oppositional Defiance Disorder

“Creating Possibilities, Inspiring Innovations”

□ Severe Acute Respiratory Syndrome (SARS)

□ Sexually Transmitted Infections (STIs)

□ Cerebrovascular disease (stroke)

“Creating Possibilities, Inspiring Innovations”

□ Chronic Obstructive Pulmonary Disease (COPD)

□ Coronary Artery Disease

□ High Blood Pressure or Hypertension 1

□ Obesity and Overweight

□ Substance Abuse: Alcohol

□ Substance Abuse: Ecstasy

□ Seventh Day Adventist

□ Roman Catholic, including Catholic Charismatic 14

“Creating Possibilities, Inspiring Innovations”

□ Homosexual (attracted to a person of same gender identity)

□ Bisexual (attracted to persons of two or more genders)

□ Asexual (A person who doesn’t have sexual attraction to anyone.)

□ Androsexual (A person attracted to masculine gender presentation)

□ Gynosexual (A person attracted to feminine gender presentation)

12. Gender Identity

“Creating Possibilities, Inspiring Innovations”

□ Transman (female e at birth but identifies as male)

“Creating Possibilities, Inspiring Innovations”

“Creating Possibilities, Inspiring Innovations”

DATA CONSENT FORM

Hence, I agree to take part in this survey.

_______February 21, 2023_____

“Creating Possibilities, Inspiring Innovations”

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___February 21, 2023_