ENROLLMENT SURVEY REPORT (Consolidated from LESF)

As of
School ID 300052
School

Total Number of Enrolled Learners within the Household

Grade
level Kinder Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6 Grade 7 Grade 8 Grade 9 Grade 10 Grade 11 Grade 12 Others

GRADE 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0
GRADE 8 0 0 0 0 0 0 0 0 0 0 0 0 0 0
GRADE 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
GRADE 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0
GRADE 11 0 0 0 0 0 0 0 0 1 0 0 0 0 0
GRADE 12 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Total 0 0 0 0 0 0 0 0 1 0 0 0 0 0

Grade Household members whoextended

can deliver Instructional Support
independ Grade Internet Connectivity
parents/ elder grand- mobile broadband computer
level family others none ent level other places None
guardians siblings parents data internet shop
members learning
GRADE 7 0 0 0 0 0 0 0 GRADE 7 0 0 0 0 0
GRADE 8 0 0 0 0 0 0 0 GRADE 8 0 0 0 0 0
GRADE 9 0 0 0 0 0 0 0 GRADE 9 0 0 0 0 0
GRADE 10 0 0 0 0 0 0 0 GRADE 10 0 0 0 0 0
GRADE 11 1 0 0 0 0 0 0 GRADE 11 0 0 0 0 0
GRADE 12 0 0 0 0 0 0 0 GRADE 12 0 0 0 0 0
Total 0 0 0 0 0
Total 1 0 0 0 0 0 0
ENROLLMENT SURVEY REPORT (Consolidated from LESF)
As of 30-Dec-99
School ID 300052
School 0

Grade Available
non-cable basic Devices
smart- for Learning at Home
desktop Grade level TOTAL ENROLLMENT
level cable TV TV cellphone phone tablet radio PC laptop none others MALE FEMALE Total
GRADE 7 0 0 0
GRADE 7 0 0 0 0 0 0 0 0 0 0 GRADE 8 0 0 0
GRADE 8 0 0 0 0 0 0 0 0 0 0 GRADE 9 0 0 0
GRADE 9 0 0 0 0 0 0 0 0 0 0 GRADE 10 0 0 0
GRADE 10 0 0 0 0 0 0 0 0 0 0 GRADE 11 0 0 0
GRADE 11 1 0 0 0 0 0 0 0 0 0 GRADE 12 0 0 0
GRADE 12 0 0 0 0 0 0 0 0 0 0
Total 0 0 0
Total 1 0 0 0 0 0 0 0 0 0

Grade onlinePreferred Distance Learning

modular Modalities lack of insufficien Possible
unstable Challenges/Difficulties
health difficulty in in Distance
conflict Learning distrac
w/ unavailable
level learning TV radio learning blended others gadgets t load internet conditions learning activities space tions others

GRADE 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
GRADE 8 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
GRADE 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
GRADE 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
GRADE 11 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
GRADE 12 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
 Possible Challenges/Difficulties in Distance Learning
lack of insufficient unstable health difficulty in conflict w/ unavailable
gadgets load internet conditions learning activities space distractions others
 COPY AND PASTE THE DATA FROM THE ELECTRONIC LEARNER ENROLLM
THE SURVEY SUMMARY WILL BE AUTO CONSOLIDATED IN THE SHEET "SS"

School Year Last Name First Name

1 2021-2022
2 2021-2022
3 2021-2022
4 2021-2022
5 2021-2022
6 2021-2022
7 2021-2022
8 2021-2022
9 2021-2022
10 2021-2022
11 2021-2022
12 2021-2022
13 2021-2022
14 2021-2022
15 2021-2022
16 2021-2022
17 2021-2022
18 2021-2022
19 2021-2022
20 2021-2022
21 2021-2022
22 2021-2022
23 2021-2022
24 2021-2022
25 2021-2022
26 2021-2022
27 2021-2022
28 2021-2022
29 2021-2022
30 2021-2022
31 2021-2022
32 2021-2022
33 2021-2022
34 2021-2022
35 2021-2022
36 2021-2022
37 2021-2022
38 2021-2022
39 2021-2022
40 2021-2022
41 2021-2022
42 2021-2022
43 2021-2022
44 2021-2022
45 2021-2022
46 2021-2022
47 2021-2022
48 2021-2022
49 2021-2022
50 2021-2022
RONIC LEARNER ENROLLMENT AND SURVEY FORM (ELESF)
USE CAPSLOCK OR BIG LETTERS IN ENCODI

PSA Birth
Extension
Middle Name LRN Certificate
Name
Number
BIG LETTERS IN ENCODING
IP/ICC

Birthdate
Age Sex Mother Tongue
(mm/dd/yyyy)

Yes/No Affiliation

ILOKO
 Special Education Needs

Religion Email Address:

Yes/No

CHRISTIANITY
Special Education Needs Assistive Technology Availability
Specification(i.e. physical, mental,
Specification(i.e. screen reader,
social disability, medical condition,
Braille, DAISY)
giftedness, among others) Yes/No
 Grade Last Grade Last School
Learner
Level to Level Year
Status
Enroll Completed Completed

WITH LRN GRADE 11 GRADE 10 2020-2021

WITH LRN GRADE 11 GRADE 10 2020-2021
WITH LRN GRADE 11 GRADE 10 2020-2021
WITH LRN GRADE 11 GRADE 10 2020-2021
WITH LRN GRADE 11 GRADE 10 2020-2021
WITH LRN GRADE 11 GRADE 10 2020-2021
WITH LRN GRADE 11 GRADE 10 2020-2021
WITH LRN GRADE 11 GRADE 10 2020-2021
WITH LRN GRADE 11 GRADE 10 2020-2021
WITH LRN GRADE 11 GRADE 10 2020-2021
WITH LRN GRADE 11 GRADE 10 2020-2021
WITH LRN GRADE 11 GRADE 10 2020-2021
WITH LRN GRADE 11 GRADE 10 2020-2021
WITH LRN GRADE 11 GRADE 10 2020-2021
WITH LRN GRADE 11 GRADE 10 2020-2021
WITH LRN GRADE 11 GRADE 10 2020-2021
WITH LRN GRADE 11 GRADE 10 2020-2021
WITH LRN GRADE 11 GRADE 10 2020-2021
WITH LRN GRADE 11 GRADE 10 2020-2021
WITH LRN GRADE 11 GRADE 10 2020-2021
WITH LRN GRADE 11 GRADE 10 2020-2021
WITH LRN GRADE 11 GRADE 10 2020-2021
WITH LRN GRADE 11 GRADE 10 2020-2021
WITH LRN GRADE 11 GRADE 10 2020-2021
WITH LRN GRADE 11 GRADE 10 2020-2021
WITH LRN GRADE 11 GRADE 10 2020-2021
WITH LRN GRADE 11 GRADE 10 2020-2021
WITH LRN GRADE 11 GRADE 10 2020-2021
WITH LRN GRADE 11 GRADE 10 2020-2021
WITH LRN GRADE 11 GRADE 10 2020-2021
WITH LRN GRADE 11 GRADE 10 2020-2021
WITH LRN GRADE 11 GRADE 10 2020-2021
WITH LRN GRADE 11 GRADE 10 2020-2021
WITH LRN GRADE 11 GRADE 10 2020-2021
WITH LRN GRADE 11 GRADE 10 2020-2021
WITH LRN GRADE 11 GRADE 10 2020-2021
WITH LRN GRADE 11 GRADE 10 2020-2021
WITH LRN GRADE 11 GRADE 10 2020-2021
WITH LRN GRADE 11 GRADE 10 2020-2021
WITH LRN GRADE 11 GRADE 10 2020-2021
WITH LRN GRADE 11 GRADE 10 2020-2021
WITH LRN GRADE 11 GRADE 10 2020-2021
WITH LRN GRADE 11 GRADE 10 2020-2021
WITH LRN GRADE 11 GRADE 10 2020-2021
WITH LRN GRADE 11 GRADE 10 2020-2021
WITH LRN GRADE 11 GRADE 10 2020-2021
WITH LRN GRADE 11 GRADE 10 2020-2021
WITH LRN GRADE 11 GRADE 10 2020-2021
WITH LRN GRADE 11 GRADE 10 2020-2021
WITH LRN GRADE 11 GRADE 10 2020-2021
 Last School Attended School ID

ILOCOS SUR NATIONAL HIGH SCHOOL 300052

ILOCOS SUR NATIONAL HIGH SCHOOL 300052
ILOCOS SUR NATIONAL HIGH SCHOOL 300052
ILOCOS SUR NATIONAL HIGH SCHOOL 300052
ILOCOS SUR NATIONAL HIGH SCHOOL 300052
ILOCOS SUR NATIONAL HIGH SCHOOL 300052
ILOCOS SUR NATIONAL HIGH SCHOOL 300052
ILOCOS SUR NATIONAL HIGH SCHOOL 300052
ILOCOS SUR NATIONAL HIGH SCHOOL 300052
ILOCOS SUR NATIONAL HIGH SCHOOL 300052
ILOCOS SUR NATIONAL HIGH SCHOOL 300052
ILOCOS SUR NATIONAL HIGH SCHOOL 300052
ILOCOS SUR NATIONAL HIGH SCHOOL 300052
ILOCOS SUR NATIONAL HIGH SCHOOL 300052
ILOCOS SUR NATIONAL HIGH SCHOOL 300052
ILOCOS SUR NATIONAL HIGH SCHOOL 300052
ILOCOS SUR NATIONAL HIGH SCHOOL 300052
ILOCOS SUR NATIONAL HIGH SCHOOL 300052
ILOCOS SUR NATIONAL HIGH SCHOOL 300052
ILOCOS SUR NATIONAL HIGH SCHOOL 300052
ILOCOS SUR NATIONAL HIGH SCHOOL 300052
ILOCOS SUR NATIONAL HIGH SCHOOL 300052
ILOCOS SUR NATIONAL HIGH SCHOOL 300052
ILOCOS SUR NATIONAL HIGH SCHOOL 300052
ILOCOS SUR NATIONAL HIGH SCHOOL 300052
ILOCOS SUR NATIONAL HIGH SCHOOL 300052
ILOCOS SUR NATIONAL HIGH SCHOOL 300052
ILOCOS SUR NATIONAL HIGH SCHOOL 300052
ILOCOS SUR NATIONAL HIGH SCHOOL 300052
ILOCOS SUR NATIONAL HIGH SCHOOL 300052
ILOCOS SUR NATIONAL HIGH SCHOOL 300052
ILOCOS SUR NATIONAL HIGH SCHOOL 300052
ILOCOS SUR NATIONAL HIGH SCHOOL 300052
ILOCOS SUR NATIONAL HIGH SCHOOL 300052
ILOCOS SUR NATIONAL HIGH SCHOOL 300052
ILOCOS SUR NATIONAL HIGH SCHOOL 300052
ILOCOS SUR NATIONAL HIGH SCHOOL 300052
ILOCOS SUR NATIONAL HIGH SCHOOL 300052
ILOCOS SUR NATIONAL HIGH SCHOOL 300052
ILOCOS SUR NATIONAL HIGH SCHOOL 300052
ILOCOS SUR NATIONAL HIGH SCHOOL 300052
ILOCOS SUR NATIONAL HIGH SCHOOL 300052
ILOCOS SUR NATIONAL HIGH SCHOOL 300052
ILOCOS SUR NATIONAL HIGH SCHOOL 300052
ILOCOS SUR NATIONAL HIGH SCHOOL 300052
ILOCOS SUR NATIONAL HIGH SCHOOL 300052
ILOCOS SUR NATIONAL HIGH SCHOOL 300052
ILOCOS SUR NATIONAL HIGH SCHOOL 300052
ILOCOS SUR NATIONAL HIGH SCHOOL 300052
ILOCOS SUR NATIONAL HIGH SCHOOL 300052
 School
School Address School to Enroll
Type

GOMEZ ST. BRGY. VII, VIGAN CITY PUBLIC ILOCOS SUR NATIONAL HIGH SCHOOL
GOMEZ ST. BRGY. VII, VIGAN CITY PUBLIC ILOCOS SUR NATIONAL HIGH SCHOOL
GOMEZ ST. BRGY. VII, VIGAN CITY PUBLIC ILOCOS SUR NATIONAL HIGH SCHOOL
GOMEZ ST. BRGY. VII, VIGAN CITY PUBLIC ILOCOS SUR NATIONAL HIGH SCHOOL
GOMEZ ST. BRGY. VII, VIGAN CITY PUBLIC ILOCOS SUR NATIONAL HIGH SCHOOL
GOMEZ ST. BRGY. VII, VIGAN CITY PUBLIC ILOCOS SUR NATIONAL HIGH SCHOOL
GOMEZ ST. BRGY. VII, VIGAN CITY PUBLIC ILOCOS SUR NATIONAL HIGH SCHOOL
GOMEZ ST. BRGY. VII, VIGAN CITY PUBLIC ILOCOS SUR NATIONAL HIGH SCHOOL
GOMEZ ST. BRGY. VII, VIGAN CITY PUBLIC ILOCOS SUR NATIONAL HIGH SCHOOL
GOMEZ ST. BRGY. VII, VIGAN CITY PUBLIC ILOCOS SUR NATIONAL HIGH SCHOOL
GOMEZ ST. BRGY. VII, VIGAN CITY PUBLIC ILOCOS SUR NATIONAL HIGH SCHOOL
GOMEZ ST. BRGY. VII, VIGAN CITY PUBLIC ILOCOS SUR NATIONAL HIGH SCHOOL
GOMEZ ST. BRGY. VII, VIGAN CITY PUBLIC ILOCOS SUR NATIONAL HIGH SCHOOL
GOMEZ ST. BRGY. VII, VIGAN CITY PUBLIC ILOCOS SUR NATIONAL HIGH SCHOOL
GOMEZ ST. BRGY. VII, VIGAN CITY PUBLIC ILOCOS SUR NATIONAL HIGH SCHOOL
GOMEZ ST. BRGY. VII, VIGAN CITY PUBLIC ILOCOS SUR NATIONAL HIGH SCHOOL
GOMEZ ST. BRGY. VII, VIGAN CITY PUBLIC ILOCOS SUR NATIONAL HIGH SCHOOL
GOMEZ ST. BRGY. VII, VIGAN CITY PUBLIC ILOCOS SUR NATIONAL HIGH SCHOOL
GOMEZ ST. BRGY. VII, VIGAN CITY PUBLIC ILOCOS SUR NATIONAL HIGH SCHOOL
GOMEZ ST. BRGY. VII, VIGAN CITY PUBLIC ILOCOS SUR NATIONAL HIGH SCHOOL
GOMEZ ST. BRGY. VII, VIGAN CITY PUBLIC ILOCOS SUR NATIONAL HIGH SCHOOL
GOMEZ ST. BRGY. VII, VIGAN CITY PUBLIC ILOCOS SUR NATIONAL HIGH SCHOOL
GOMEZ ST. BRGY. VII, VIGAN CITY PUBLIC ILOCOS SUR NATIONAL HIGH SCHOOL
GOMEZ ST. BRGY. VII, VIGAN CITY PUBLIC ILOCOS SUR NATIONAL HIGH SCHOOL
GOMEZ ST. BRGY. VII, VIGAN CITY PUBLIC ILOCOS SUR NATIONAL HIGH SCHOOL
GOMEZ ST. BRGY. VII, VIGAN CITY PUBLIC ILOCOS SUR NATIONAL HIGH SCHOOL
GOMEZ ST. BRGY. VII, VIGAN CITY PUBLIC ILOCOS SUR NATIONAL HIGH SCHOOL
GOMEZ ST. BRGY. VII, VIGAN CITY PUBLIC ILOCOS SUR NATIONAL HIGH SCHOOL
GOMEZ ST. BRGY. VII, VIGAN CITY PUBLIC ILOCOS SUR NATIONAL HIGH SCHOOL
GOMEZ ST. BRGY. VII, VIGAN CITY PUBLIC ILOCOS SUR NATIONAL HIGH SCHOOL
GOMEZ ST. BRGY. VII, VIGAN CITY PUBLIC ILOCOS SUR NATIONAL HIGH SCHOOL
GOMEZ ST. BRGY. VII, VIGAN CITY PUBLIC ILOCOS SUR NATIONAL HIGH SCHOOL
GOMEZ ST. BRGY. VII, VIGAN CITY PUBLIC ILOCOS SUR NATIONAL HIGH SCHOOL
GOMEZ ST. BRGY. VII, VIGAN CITY PUBLIC ILOCOS SUR NATIONAL HIGH SCHOOL
GOMEZ ST. BRGY. VII, VIGAN CITY PUBLIC ILOCOS SUR NATIONAL HIGH SCHOOL
GOMEZ ST. BRGY. VII, VIGAN CITY PUBLIC ILOCOS SUR NATIONAL HIGH SCHOOL
GOMEZ ST. BRGY. VII, VIGAN CITY PUBLIC ILOCOS SUR NATIONAL HIGH SCHOOL
GOMEZ ST. BRGY. VII, VIGAN CITY PUBLIC ILOCOS SUR NATIONAL HIGH SCHOOL
GOMEZ ST. BRGY. VII, VIGAN CITY PUBLIC ILOCOS SUR NATIONAL HIGH SCHOOL
GOMEZ ST. BRGY. VII, VIGAN CITY PUBLIC ILOCOS SUR NATIONAL HIGH SCHOOL
GOMEZ ST. BRGY. VII, VIGAN CITY PUBLIC ILOCOS SUR NATIONAL HIGH SCHOOL
GOMEZ ST. BRGY. VII, VIGAN CITY PUBLIC ILOCOS SUR NATIONAL HIGH SCHOOL
GOMEZ ST. BRGY. VII, VIGAN CITY PUBLIC ILOCOS SUR NATIONAL HIGH SCHOOL
GOMEZ ST. BRGY. VII, VIGAN CITY PUBLIC ILOCOS SUR NATIONAL HIGH SCHOOL
GOMEZ ST. BRGY. VII, VIGAN CITY PUBLIC ILOCOS SUR NATIONAL HIGH SCHOOL
GOMEZ ST. BRGY. VII, VIGAN CITY PUBLIC ILOCOS SUR NATIONAL HIGH SCHOOL
GOMEZ ST. BRGY. VII, VIGAN CITY PUBLIC ILOCOS SUR NATIONAL HIGH SCHOOL
GOMEZ ST. BRGY. VII, VIGAN CITY PUBLIC ILOCOS SUR NATIONAL HIGH SCHOOL
GOMEZ ST. BRGY. VII, VIGAN CITY PUBLIC ILOCOS SUR NATIONAL HIGH SCHOOL
GOMEZ ST. BRGY. VII, VIGAN CITY PUBLIC ILOCOS SUR NATIONAL HIGH SCHOOL
School ID School Address Semester

300052 GOMEZ ST.BRGY. VII, VIGAN CITY

300052 GOMEZ ST.BRGY. VII, VIGAN CITY
300052 GOMEZ ST.BRGY. VII, VIGAN CITY
300052 GOMEZ ST.BRGY. VII, VIGAN CITY
300052 GOMEZ ST.BRGY. VII, VIGAN CITY
300052 GOMEZ ST.BRGY. VII, VIGAN CITY
300052 GOMEZ ST.BRGY. VII, VIGAN CITY
300052 GOMEZ ST.BRGY. VII, VIGAN CITY
300052 GOMEZ ST.BRGY. VII, VIGAN CITY
300052 GOMEZ ST.BRGY. VII, VIGAN CITY
300052 GOMEZ ST.BRGY. VII, VIGAN CITY
300052 GOMEZ ST.BRGY. VII, VIGAN CITY
300052 GOMEZ ST.BRGY. VII, VIGAN CITY
300052 GOMEZ ST.BRGY. VII, VIGAN CITY
300052 GOMEZ ST.BRGY. VII, VIGAN CITY
300052 GOMEZ ST.BRGY. VII, VIGAN CITY
300052 GOMEZ ST.BRGY. VII, VIGAN CITY
300052 GOMEZ ST.BRGY. VII, VIGAN CITY
300052 GOMEZ ST.BRGY. VII, VIGAN CITY
300052 GOMEZ ST.BRGY. VII, VIGAN CITY
300052 GOMEZ ST.BRGY. VII, VIGAN CITY
300052 GOMEZ ST.BRGY. VII, VIGAN CITY
300052 GOMEZ ST.BRGY. VII, VIGAN CITY
300052 GOMEZ ST.BRGY. VII, VIGAN CITY
300052 GOMEZ ST.BRGY. VII, VIGAN CITY
300052 GOMEZ ST.BRGY. VII, VIGAN CITY
300052 GOMEZ ST.BRGY. VII, VIGAN CITY
300052 GOMEZ ST.BRGY. VII, VIGAN CITY
300052 GOMEZ ST.BRGY. VII, VIGAN CITY
300052 GOMEZ ST.BRGY. VII, VIGAN CITY
300052 GOMEZ ST.BRGY. VII, VIGAN CITY
300052 GOMEZ ST.BRGY. VII, VIGAN CITY
300052 GOMEZ ST.BRGY. VII, VIGAN CITY
300052 GOMEZ ST.BRGY. VII, VIGAN CITY
300052 GOMEZ ST.BRGY. VII, VIGAN CITY
300052 GOMEZ ST.BRGY. VII, VIGAN CITY
300052 GOMEZ ST.BRGY. VII, VIGAN CITY
300052 GOMEZ ST.BRGY. VII, VIGAN CITY
300052 GOMEZ ST.BRGY. VII, VIGAN CITY
300052 GOMEZ ST.BRGY. VII, VIGAN CITY
300052 GOMEZ ST.BRGY. VII, VIGAN CITY
300052 GOMEZ ST.BRGY. VII, VIGAN CITY
300052 GOMEZ ST.BRGY. VII, VIGAN CITY
300052 GOMEZ ST.BRGY. VII, VIGAN CITY
300052 GOMEZ ST.BRGY. VII, VIGAN CITY
300052 GOMEZ ST.BRGY. VII, VIGAN CITY
300052 GOMEZ ST.BRGY. VII, VIGAN CITY
300052 GOMEZ ST.BRGY. VII, VIGAN CITY
300052 GOMEZ ST.BRGY. VII, VIGAN CITY
300052 GOMEZ ST.BRGY. VII, VIGAN CITY
 Home Address ( HOUSE/ST NO., ZONE/BRGY,CITY/MUN
HOUSE/ST. NO. BRGY
(IF
Track Strand APPLICABLE) example:
example: BRGY. IX OR
#31 RAOIS
JOSE STREET
OUSE/ST NO., ZONE/BRGY,CITY/MUNICIPALITY/PROVINCE)
CITY/MUNICIPALITY PROVINCE

EXAMPLE:

VIGAN CITY EXAMPLE: ILOCOS SUR

 Highest Educational Attainment(NO FORMAL
SCHOOLING,NO FORMAL SCHOOLING BUT ABLE
Father's Name (LAST,FIRST, MIDDLE READ & WRITE,ELEMENTARY LEVEL,
NAME) ELEMENTARY GRADUATE,HIGHSCHOOL
LEVEL,HIGH SCHOOL GRADUATE, AFTER HIGH
SCHOOL EDUCATION)
 Mother's Name (LAST,FIRST, MIDDLE
Contact Number
NAME)
 Highest Educational Attainment(NO FORMAL
SCHOOLING,NO FORMAL SCHOOLING BUT ABLE
READ & WRITE,ELEMENTARY LEVEL,
ELEMENTARY GRADUATE,HIGHSCHOOL Contact Number
LEVEL,HIGH SCHOOL GRADUATE, AFTER HIGH
SCHOOL EDUCATION)
 Highest Educational Attainment(NO FORMAL
IF NOT LIVING WITH PARENTS SCHOOLING,NO FORMAL SCHOOLING BUT
ABLE READ & WRITE,ELEMENTARY LEVEL,
Guardian's Name (LAST,FIRST, ELEMENTARY GRADUATE,HIGHSCHOOL
MIDDLE NAME) LEVEL,HIGH SCHOOL GRADUATE, AFTER HIGH
SCHOOL EDUCATION)
 Total Number of Enrolled L
4Ps
Contact Number Beneficiary (
Kinder Grade 1 Grade 2 Grade 3
YES/NO)
otal Number of Enrolled Learners within the Household ( USE NUMBERS)

Grade 4 Grade 5 Grade 6 Grade 7 Grade 8 Grade 9 Grade 10 Grade 11 Grade 12

1
 Household members who can deliver Instructional Support (Put "1")

Others(COL
LEGE/VOCA
TIONAL)
parents/ elder extended family
guardians siblings grand-parents members others none

1
 Available Devices for Learning at Home(PUT "1")

non-
independent cable cable basic smart-
learning TV TV cellphone phone tablet radio desktop PC

1
 Internet Connectivity (PUT "1")

mobile broadband other

laptop none others Yes/No data internet computer shop places None
 Preferred Distance Learning Modalities (PUT "1")
Combination
of face to
modular modular face with
learning learning other
online learning TV radio (digital) (printed) modalities blended
 Possible Challenges/Difficulties in Distance Learning

lack of insufficient unstable health

gadgets load internet conditions difficulty in learning
fficulties in Distance Learning

unavailable
conflict w/ activities space distractions others
LIMITED FACE TO FACE If the answer is no, please select 1 major consideration
Limited or no
available Existing
In case limited face to face will transportation Illness or
be allowed, are you willing to Fear of getting from home to health Helping in
allow your child / children to infected of school and realated household
participate?(YES/NO) Corona Virus vice versa concers chores