A.

EMPLOYMENT STATUS

Full time Part time Self- Unemployed due Not working Working
employed to ECQ from home
Yes No
Father
Mother
Guardian

B. BENEFECIARY OF 4Ps?

YES NO

C. HOW DOES YOUR CHILD GO TO SCHOOL

walking public commute family-owned vehicle school service

D. HOW MANY OF YOUR HOUSEHOLD MEMBERS (INCLUDING THE ENROLLEE) ARE STUDYING IN
SCHOOL YEAR 2020-2021? PLEASE SPECIFY EACH.

Gr. 1 Gr. 7
Gr. 2 Gr. 8
Gr. 3 Gr. 9
Gr. 4 Gr. 10
Gr. 5 Gr. 11
Gr. 6 Gr. 12

E. WHO AMONG THE HOUSEHOLD MEMBERS CAN PROVIDE INSTRUCTIONAL SUPPORT TO THE CHILD’S
DISTANCE LEARNING? CHOOSE ALL THAT APPLIES.

parents/ elder siblings grandparents extended others (tutor, none able to do

guardians members of house helper) independent
the family learning
F. WHAT DEVICES ARE AVAILABLE AT HOME THAT THE LEARNER CAN USE FOR LEARNING?

-cable TV
-non-cable TV
-basic cellphone
-smartphone
-with tablet/ipod
- radio
- desktop computer
- laptop
- none
-others
G. DO YOU HAVE A WAY TO CONNECT TO THE INTERNET?
-Yes
-No

H. HOW DO YOU CONNECT TO THE INTERNET?

-own mobile data
-own broadband internet (DSL, wireless fiber, satellite)
-computer shop
-other places outside the home with internet connection
-none
I. WHAT DISTANCE LEARNING MODALITY/IES DO YOU PREFER FOR YOUR CHILD?
-online learning
-television
-radio
- modular learning
- combination of face to face with other modalities
-others

J. WHAT ARE THE CHALLENGES THAT MAY AFFECT YOUR CHILD’S LEARNING PROCESS THROUGH
DISTANCE EDUCATION?

-lack of available gadgets/ equipment

-insufficient load/ data allowance
-unstable mobile/ internet connection
- existing health condition/s
- difficulty in independent learning
- conflict with other activities (i.e., house chores)
- No or lack of available space for studying
-distractions (i.e., social media, noise from community/neighbor)
-others