Suggested Template for School Level Survey

DEPARTMENT OF EDUCATION
Regional Office No. VIII

Field Survey on Out-of-School Children (OOSC) in the Barangays

(Ages 5-18 Years)
School Year 2016-2017
Barangay:
CONALUM
Municipality: INOPACAN

Division:

Name
Surname

1
2
3
4
5
6
7
8
9
10

NAVALES
DADULA

First Name

BEN
ALONG

MI

Highest
completed
grade/level

None
NONE

Date of
Birth
Age
(mm-dd-yy)

4-24-2011
11-23-04

Sex

5M
11 M

Address

Conalum, Inopacan
Conalum, Inopacan

PWD
(YES or
NO)

NO
YES

Distance
from Home
to School
(in Km)

*Parents' Occupational Status

Father

LABORER
DECEASED

Mother

*Hindering
Factors

UNEMPLOYED
MIDWIFE

*Utilized
Intervention(s),
(if any)

Source(s) of Information
Planned
Intervention(s)
*BE
Others:
in the future
BHW/ BNS
C
(specify)

NONE
NONE

BNS

BNS

*Hindering Factors - includes but not limited to Family, Individual, Community and School (FICS) issues which should further be specified/itemized as reason(s) per identified OOSC that eventually
prevented him in attending school. Options are as follows:Early marriage, no regular transportation, high cost of education, illness/disability, housekeeping/housework, Employment/looking for work, lack of personal interest, cannot cope with
school work, others.
*Utilized Intervention(s) - includes but not limited to DepEd-initiated strategies which should further be specified/itemized as factor(s) per identified OOSC that facilitated/motivated him to go to school.
Options under this section are the following: ABOT-ALAM program, ALS IPEd, ALS ALIVE, ALS regular programs (either BLP, A&E, INfEd), others.
Parents' Occupation- Refers to parents' source of income/subsistence. Options under this field are as follows: Employed (either in public or private agencies or companies), self-employed, seasonally employed, and unemployed
*BEC - Barangay Education Committee

Prepared by:

Checked/Verified:

School ALS Coordinator

School Head

Suggested Template for District Collated Report

Page 1
DEPARTMENT OF EDUCATION
Regional Office No. VIII

District Collated Report on Out-of-School Youths (OOSY)

School Year 2016-2017
Municipality:
Barangay:___________________________

INOPACAN
CONALUM

Division:
Number of Out-of-School Youths by Age

Barangay

5 & below
M

1
2
3
4
5
6
7
8
9
10

CONALUM

6-11
T

12-15
T

16 - 25
T

26-30
T

13

M
6

F
6

T
4

10

19

12

TOTAL
*Hindering Factors - includes but not limited to Family, Individual, Community and School (FICS) issues which should further be specified/itemized as reason(s) per identified OOSC that eventually
prevented him in attending school. Options are as follows:Early marriage, no regular transportation, high cost of education,
illness/disability, housekeeping/housework, Employment/looking for work, lack of personal interest, cannot cope with school
work, others.
*Utilized Intervention(s) - includes but not limited to DepEd-initiated strategies which should further be specified/itemized as factor(s) per identified OOSC that facilitated/motivated him to go to school.
Options under this section are the following: OSHP, ABOT-ALAM program, ALS IPEd, ALS ALIVE, ALS regular programs (either BLP, A&E, INfEd), others.
Parents' Occupation- Refers to parents' source of income/subsistence. Options under this field are as follows: Employed (either in public or private agencies or companies), self-employed, seasonally employed, and unemployed
*BEC - Barangay Education Committee

Prepared by:

Checked/Verified:

School ALS Coordinator

School Head

No. of OSYs According to

Distance from Home to School
(in Km)

TOTAL

31-40
T

LEYTE

0-3.99

31

31

4-5.99

6 & Farther

Page 2
Municipality:INOPACAN
Name of Brgy: CONALUM

Planned
Source(s) of Information
* Utilized
Interventions in the
Interventions
Future
Female
BHW/BNS *BEC Others: (specify)

SEX

Hindering Factors per

Barangay

Parents' Occupational Status

Male
Father
Employed

Self-employed

Mother

Seasonally employed

Unemployed

12

Prepared by:

School ALS Coordinator

Employed

Self-employed

Seasonally employed

Early Marriages
Unemployed No. Regular Transportation
16 High Cost of Education
Illness/disability
Housekeeping/Housework
Employment/looking for work
Lack of personal interest
Cannot cope with school work
Others

/
/

/
/

Checked/Verified:

School Head

: (specify)

ead

Field

Surname Given Name

Zanoria

Ed

MI
B.

Date of Birth Age

11/17/1983

Age group Sex

32.8333 30-39

Male

DEPARTMENT OF EDUCATION
Regional Office No. VIII

Field Survey on Out-of-School Children (OOSC) in the Baranga

School Year 2016-2017

Address
Brgy.93 Bagacay

Distance from
PWD (Yes
Home to school
or NO)
(in Km)
2km

Father's
Mother's
occupational status occupational status
unemployed

unemployed

) in the Barangays

Hindering Factors

Utilized
Interventions (if
any)

lack of personal interest ALS regular program

Planned
Intervention(s) Source of Information
in the Future