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LEARNER ENROLLMENT AND SURVEY FORM
GRADE LEVEL SEX BELONG TO INDIGENOUS PEOPLE MOTHER TONGUE RELIGION LEARNERS W/SPED NEEDS
M F YES NO WARAY TAGALOG ENGLISH
KINDER
G-1
G-2
G-3
G-4
G-5
G-6
Total
PARENT/GUARDIAN INFORMATION
FATHER MOTHER GUARDIAN
E H
S
C
G
V M/
D
N
A
O F
T
P
T
S
E
U
E
N
W
WF
H
4PS E H
S
C
G
V M/
D
N
A
O F
T
P
T
S
E
U
E
N
W
WF
H
4PS E H
S
C
G
V M/
D
N
A
O F
T
P
T
S
E
U
E
N
W
WFH 4PS
Y N Y N Y N Y N
K
G-1
G-2
G-3
G-4
G-5
G-6
G-7
Tot
al
HOUSEHOLD CAPACITY AND ACCESS TO DISTANCE LEARNING
GRAD
E
LEVEL
How does your
child go to
school?
Household members studying in S.Y 2020-2021 Who will support to the child’s
distant learning?
Devices available at home used for learning
W P
C
FO
V
S
S
k G
1
G
2
G
3
G
4
G
5
G
6
G
7
G
8
G
9
G1
0
G1
1
G1
2
O P/
G
E
S
GP Extende
d
Family
O N IND C TV NC
TV
Basc
Cp
Smartp
hone
Table
t
Ra
dio
Desktop
computer
Lapto
p
N O
KINDE
R
G-1
G-2
G-3
G-4
G-5
G-6
G-7
Total
GRADE
LEVEL
Do you have a
way to connect
to the internet?
How do you connect to the internet? What distance learning modalities do you
prefer for your child?
Challenges that may affect your child’s learning process
Y N Own
Mob
Data
Own
Broadband
Comp
Shop
Other
Places
No
ne
Online
Learnin
g
TV Radi
o
Module Comb
of face
to face
Other
s
Lack of
availabl
e
gadgets
Insufficient
load/data
Unstable
mobile or
internet
connectio
n
Existing
Health
Conditio
ns
Difficulty in
independen
t learning
Conflict
w/other
activities
No or lack
of space
for
studying
Distr
actio
ns
Others
KINDE
R
G-1
G-2
G-3
G-4
G-5
G-6
G-7
Total

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CONSOLIDATOR.docx

  • 1. LEARNER ENROLLMENT AND SURVEY FORM GRADE LEVEL SEX BELONG TO INDIGENOUS PEOPLE MOTHER TONGUE RELIGION LEARNERS W/SPED NEEDS M F YES NO WARAY TAGALOG ENGLISH KINDER G-1 G-2 G-3 G-4 G-5 G-6 Total PARENT/GUARDIAN INFORMATION FATHER MOTHER GUARDIAN E H S C G V M/ D N A O F T P T S E U E N W WF H 4PS E H S C G V M/ D N A O F T P T S E U E N W WF H 4PS E H S C G V M/ D N A O F T P T S E U E N W WFH 4PS Y N Y N Y N Y N K G-1 G-2 G-3 G-4 G-5 G-6 G-7 Tot al
  • 2. HOUSEHOLD CAPACITY AND ACCESS TO DISTANCE LEARNING GRAD E LEVEL How does your child go to school? Household members studying in S.Y 2020-2021 Who will support to the child’s distant learning? Devices available at home used for learning W P C FO V S S k G 1 G 2 G 3 G 4 G 5 G 6 G 7 G 8 G 9 G1 0 G1 1 G1 2 O P/ G E S GP Extende d Family O N IND C TV NC TV Basc Cp Smartp hone Table t Ra dio Desktop computer Lapto p N O KINDE R G-1 G-2 G-3 G-4 G-5 G-6 G-7 Total GRADE LEVEL Do you have a way to connect to the internet? How do you connect to the internet? What distance learning modalities do you prefer for your child? Challenges that may affect your child’s learning process Y N Own Mob Data Own Broadband Comp Shop Other Places No ne Online Learnin g TV Radi o Module Comb of face to face Other s Lack of availabl e gadgets Insufficient load/data Unstable mobile or internet connectio n Existing Health Conditio ns Difficulty in independen t learning Conflict w/other activities No or lack of space for studying Distr actio ns Others KINDE R G-1 G-2 G-3 G-4 G-5