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District I
GABU ELEMENTARY SCHOOL
Laoag City
Pedicab
others _______________
4. Has any member of the family ever dropped out of school?
Yes
No
Yes
No
If yes, from what source(s) (specify) ___________________________________________________
6. With whom does the pupil live?
Both Parents
Mother
Father
Others
Mother
Father
(specify) __________________
7. Who helps the pupil in doing homework?
None
Both Parents
Others (specify) __________________
8. Information on Parents
Information
Name
Age
Address
Nationality
Ethnic Affiliation
Religion
Language(s)/Dialec
t(s)
Father
Living
Mother
Living
Deceased
Deceased
spoken
9. Parental Marital Status (Please check)
Married
Live-in
Widow(er)
Annulled
Separated
10.List all the members of the household including those who have migrated.
Specify/check the information needed.
Name of
Migrated
Relationshi
(how
Household Sex Age
Education
p to Pupil
long)
Member
Highest
ALS
Grade/Yea
Enrolled/
Course
r/
Complet
M F
Degree Complet
ed ECE*
Complete
ed
d
rents house
semi-concrete
Occupation
flush
no toilet
pit
water sealed
books