Learner Enrollment Survey Form
If you're planning to survey learners online concerning their experience, direction, and areas for improvements, then the Learner Enrollment Survey Form is a good start for you! This is to serve as your template. You'll need to customize it with your own questions to fit your specific situation.
Time to complete
3 minutes
Eligibility
Everyone is eligible to fill the Learner Enrollment Survey Form.
Questions for Learner Enrollment Survey Form
School Year
Grade Level to enroll
Last grade level completed
Last school year completed
Birth Certificate No
Learner Reference Number
FIRST NAME
MIDDLE NAME
LAST NAME
Date of Birth
Does the learner have special education needs? (i.e. physical, mental, developmental disability, medical condition, giftedness, among others)
- Yes
- No
PARENT/ GUARDIAN INFORMATION
- Father
- Mother
- Guardian
Name
Highest Educational Attainment
- Elementary graduate
- High School graduate
- College graduate
- Vocational
- Master’s/Doctorate degree
- Did not attend school
Employment Status
- Full time
- Part time
- Self-employed (i.e. family business)
- Unemployed due to community quarantine
- Not working
Contact Number
Contact Email
How does your child go to school? Choose all that applies
- walking
- public commute (land/ water)
- family-owned vehicle
- school service
What devices are available at home that the learner can use for learning? Check all that applies.
- cable TV
- radio
- non-cable TV
- desktop computer
- basic cellphone
- laptop
- smartphone
- tablet
- none
Do you have a way to connect to the internet?
- Yes
- No
How do you connect to the internet? Choose all that applies
- own mobile data
- own broadband internet (DSL, wireless fiber, satellite)
- computer shop
- other places outside the home with internet connection (library, barangay/ municipal hall, neighbor, relatives)
- none
What distance learning modality/ies do you prefer for your child? Choose all that applies
- online learning
- television
- radio
- modular learning
- combination of face to face with other modalities
- Other
What are the challenges that may affect your child’s learning process through distance education? Choose all that applies
- 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)
- distractions (i.e., social media, noise from community/neighbor)
- No or lack of available space for studying
- 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
Similar Ideas
- Learner Enrollment Survey Form
- Parent/Guardian Enrollment Survey Form
- Teacher Enrollment Survey Form
Here are some FAQs and additional information
on Learner Enrollment Survey Form
What is the purpose of the learner enrollment survey form?
When an organization is looking for ways to improve and is eager to give its students a positive learning experience, the learner enrollment survey is a good place to begin.
Who is this learner enrollment survey form for?
The survey template available in Blocksurvey is made for the parents to share their views about the learning opportunities and facilities provided for their child.
What is this learners enrollment survey form for?
Learners enrollment survey form available for parents is for gaining actionable insights that pave the way for the organization to know more about the learner’s educational needs, the facilities they already have and the facilities they require from the organization, etc.
How to create the learner enrollment survey form?
You can create the learner enrollment survey form at ease through the Blocksurvey template.
Want to use this template?
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