Académique Documents
Professionnel Documents
Culture Documents
A3. Returning
Series
A1. School Year Learner (Balik-
No.
Aral)?
1 2020-2021 1 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
TOTAL 0 1 0 0 0 0 1 0 0 0 0 0
Prepared by:
Name of Teacher:
Previous SY Grade & Section:
Name of School:
Date Submitted:
vel to enroll: A5. Last grade level completed: A6. Last school year complete
2019-2020
2018-2019
2017-2018
2016-2017
2015-2016
2014-2015
G9 G10 G11 G12 K G1 G2 G3 G4 G5 G6 G7 G8 G9 G10 G11 G12
1 1
0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
. Last school year completed:
Not Applicable
PREVIOUS SCHOOL any.
2013-2014
2012-2013
2011-2012
2010-2011
Others
Not Applicable
Private
Private
Public
Public
Lukban St., Tacloban Cith 1 San Fernando Central School
1 0 0 0 0
A15. Chosen Track to A16. Chosen Strand to enroll (If any)?
enroll? (for SHS) (for SHS)
A14. Semester to
enroll in?
(for SHS)
12/23/2010 9 1 1
1 0 0 1
B16. Do you have any
B14. Does the learner have assistive technology devices
Special Education needs? available at home? (i.e. scree
reader, Braille, DAISY)?
B12. Mother B15. If YES, please
B13. Religion:
Tongue: specify:
Yes No Yes No
45 Rosal St. Brgy. 106-Sto. Nino Tacloban City Leyte Region VIII
name)
C1. Father's Full Name
(surname, full name, middle
Elementary
Graduate
High School
Graduate
College Graduate
Vocational
Master's/Doctorat
e degree
C2. Highest Educational Attainment
Full time
Part time
Sel-employed (i.e.
family business)
Unemployed due
C3. Employment Status
to ECQ
0 0 0 0 0 0 0 0 0 0
C4. Working from
nt Status C8. Highest Educational Attainment
home due to ECQ?
C5. Contact
number/s C7. Mother's Full Maiden Name
(cellphone/telephon (surname, first name, middle name)
College Graduate
e)
Not working
High School
Elementary
Graduate
Graduate
Yes No
1 Full time
Part time
Sel-employed (i.e.
family business)
C9. Employment Status
Unemployed due
to ECQ
Not working
Yes
ECQ?
No
C10. Working
from home due to
1
0 0 0 1 0 0 0 0 0 1
C14. Highest Educational Attainment C15. Em
Master's/Doctorat
(cellphone/telephon
College Graduate
High School
Elementary
Vocational
Graduate
Graduate
e degree
Full time
school
9273456790
0 0 0 0 0 0 0
C16. Working from D1. How does your child go to school?
C15. Employment Status
home due to ECQ? Choose all that applies
C17. Contact
number/s
(cellphone/telephon
Sel-employed (i.e.
Unemployed due
public commute
family business)
family-owned
(land/water)
e)
Not working
Part time
walking
vehicle
to ECQ
Yes No
1
0 0 0 0 0 0 0 1 0
our child go to school? D2. How many of your household members (including the enrollee) are studying in D3. Who among the household members can p
all that applies School Year 2020-2021? Please specify each. child's distance learning?Choo
Grandparents
Elder siblings
Grade 10
Grade 11
Grade 12
guardian
Parents/
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Grade 7
Grade 8
Grade 9
Kinder
1 1 1 1
0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 1 0 1
household members can provide instructional support to the D4. What devices are available at home that the learner can use for learning?Choose all
d's distance learning?Choose all that applies. that applies.
members of the
Basic cellphone
Non-cable TV
(tutor/house
independent
Smartphone
Able to do
Computer
Extended
Cable TV
Desktop
learning
helper)
Laptop
Others
Tablet
family
Radio
None
None
1 1 1 1
0 0 0 0 1 0 0 1 0 1 0 1 0
D5. Do you have any
r learning?Choose all
way to connect to the D6. How do you connect to the internet?Choose all that applies.
internet?
Yes No Own mobile data DSL, wireless fiber, Computer shop internet connection (library, None
satelite barangay/municipal hall, neighbor,
relatives)
1 1
0 1 0 0 1 0 0 0
D7. What distance learning modality/ies do you prefer for your child?Choose all that
D8. What are the challenges that may effect your child's l
applies.
1 1 1
0 0 0 1 1 0 0 1
allenges that may effect your child's learning process through distance education?Choose all that applies. [Lack of available gadgets/equipment]
1
1 0 0 0 0 0
able gadgets/equipment]
Other
0