Online Enrollment and Survey Form In-coming Grade 9

School Enrollment Survey
Instructions:
1. This enrollment survey shall be answered by the parent/guardian of the learner
2. Please read the questions carefully and fill in all applicable spaces and type your answers in CAPITAL letters. For items not applicable, choose N/A.
3.For questions/ clarifications, please ask for the assistance of the teacher/
person-in-charge.
A. GRADE LEVEL AND SCHOOL INFORMATION
A1.School Year*
A4.Grade Level to enroll*
A5.Last Grade level completed*
A7. Last School Attended:*
A8. School Address*
A10. School Type
PublicPrivate
B.STUDENT INFORMATION
B2. Learner Reference Number (LRN)*
B3. LAST NAME*
B4. FIRST NAME*
B5. MIDDLE NAME*
B6. EXTENSION NAME e.g. Jr., III (N/A if not applicable) *
B7. Date of Birth *
MonthDayYear
B8. Age*
B9. Sex*
MaleFemale
B18. Address*
House Number and Street
Barangay
CityProvince
Postal / Zip Code
C. PARENT/GUARDIAN INFORMATION
C1. FATHER *
First NameMiddle NameLast Name
C2. Highest Educational Attainment*
Elementary graduateHigh School graduateCollege graduateVocationalMaster’s/Doctorate degreeDid not attend schoolN/A (If not applicable)
C3. Employment Status*
Full timePart timeSelf-employed (i.e.family business)Unemployed due to ECQNot workingN/A (if not applicable)
C4. Working from home due to ECQ?*
YesNoN/A (if not applicable)
C5. Contact No.*
(cellphone/ telephone)
C7. MOTHER (Maiden Name) *
First NameMiddle NameLast Name
C8. Highest Educational Attainment*
Elementary graduateHigh School graduateCollege graduateVocationalMaster’s/Doctorate degreeDid not attend schoolN/A (if not applicable)
C9. Employment Status*
Full timePart timeSelf-employed (i.e.family business)Unemployed due to ECQNot workingN/A (if not applicable)
C10. Working from home due to ECQ?*
YesNoN/A (if not applicable)
C11. Contact No.*
(cellphone/ telephone)
C13. GUARDIAN *
First NameMiddle NameLast Name
C14. Highest Educational Attainment*
Elementary graduateHigh School graduateCollege graduateVocationalMaster’s/Doctorate degreeDid not attend schoolN/A (if not applicable)
C15. Employment Status*
Full timePart timeSelf-employed (i.e.family business)Unemployed due to ECQNot workingN/A (if not applicable)
C16. Working from home due to ECQ?*
YesNoN/A (if not applicable)
C17. Contact No.*
(cellphone/ telephone)
D. HOUSEHOLD CAPACITY AND ACCESS TO DISTANCE LEARNING
D1. How does your child go to school? Choose all that applies.*
walkingpublic commute (land/ water)family-owned vehicleschool service

D2. How many of your household members (including the enrollee) are studying in School Year 2020-2021? Please specify each.*

	Number of household members are studying
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
ALS
Others (ie college, vocational, etc)

D3. Who among the household members can provide instructional support to the child’s distance learning? Choose all that applies.*
parents/ guardianselder siblingsgrandparentsextended members ofthe familyNoneable to do independent learningothers (tutor, house helper)
D4. What devices are available at home that the learner can use for learning? Check all that applies.*
cable TVnon-cable TVbasic cellphonesmartphonetabletradiodesktop computerlaptopnoneothers
D5. Do you have a way to connect to the internet?*
YesNo (if No click N/A in D6 and proceed to D7)
D6. How do you connect to the internet? Choose all that applies.*
own mobile dataown broadband internet (DSL, wireless fiber, satellite)computer shopother places outside the home with internet connection(library, barangay/ municipal hall, neighbor, relatives)noneN/A ( if Not Applicable)
D7. What distance learning modality/ies do you prefer for your child? Choose all that applies*
online learningtelevisionradiomodular learningcombination of face to face with other modalitiesothers
D8. Whatare the challenges that may affect your child’s learning process through distance education? Choose all that applies.*
lack of available gadgets/ equipmentinsufficient load/data allowanceunstable mobile/internet connectionexisting health condition/sdifficulty in independent learningconflict with other activities (i.e., house chores)high electrical consumptiondistractions (i.e.,social media, noise from community/neighbor)others
I hereby certify that the above information given are true and correct to the best of my knowledge and I allow the Department of Education to use my child’s details to create and/or update his/her learner profile in the Learner Information System. The information herein shall be treated as confidential in compliance with the Data Privacy Act of 2012.
Signature*
Clear
Rating *

just click the star
Made by: L.Bernal
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School Enrollment Survey