CTC ECW MYRP ASER baseline Literacy and Numeracy

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Location
  Address

• State

  - Borno

  - Adamawa

  - Yobe

• L.G.A

  - Borno

  - Adamawa

  - Yobe

• Ward

  - Borno

  - Adamawa

  - Yobe

• Do you give NRC permission to use this information to inform NRC project activities?

  Yes

  No

  N/A

• - Note the respondent unwillingness to proceed

• What is your name?

• Gender

  Male

  Fmeale

• Age

• Displacement Status

  - IDP

  Host Community

  Returnee

  Refugee

• Specify as appropriate

  Community-based IDP

  Camp-based IDP

• Which country are you displaced from?

• Are you living with any form of disability?

  Yes

  No

  N/A

• What type of disability do you have?

  Select Difficulty in seeing Difficulty in hearing Difficulty walking or climbing steps Difficulty in remembering and concentrating Difficulty in communicating or being understood Others

  • Difficulty in seeing
  • Difficulty in hearing
  • Difficulty walking or climbing steps
  • Difficulty in remembering and concentrating
  • Difficulty in communicating or being understood
  • Others

• Specify the reason

I am going to ask you some questions to test your reading and arithmetic skills. Feel free to stop at any point.

• Literacy Level

  Select Level 0 Level 1 Level 2 Level 3 Level 4 Level 5

  • Level 0
  • Level 1
  • Level 2
  • Level 3
  • Level 4
  • Level 5

• Yes

  No

  N/A

• which country are you displaced from?

• Are you living with any form of disability?

  Yes

  No

  N/A

• what type of disability do you have?

  Select Difficulty in seeing Difficulty in hearing Difficulty walking or climbing steps Difficulty in remembering and concentrating Difficulty in communicating or being understood Others

  • Difficulty in seeing
  • Difficulty in hearing
  • Difficulty walking or climbing steps
  • Difficulty in remembering and concentrating
  • Difficulty in communicating or being understood
  • Others

• Specify the reason

I am going to ask you some questions to test your reading and arithmetic skills. Feel free to stop at any point.

• Literacy Level

  Select Level 0 Level 1 Level 2 Level 3 Level 4 Level 5

  • Level 0
  • Level 1
  • Level 2
  • Level 3
  • Level 4
  • Level 5

• Numeracy Level

  Select Level 0 Level 1 Level 2 Level 3 Level 4 Level 5

  • Level 0
  • Level 1
  • Level 2
  • Level 3
  • Level 4
  • Level 5

• Respondent education category

  Formal School

  Non- Formal School

• school, name of school?

• Level

  Select Primary 1 Primary 2 Primary 3 Primary 4 Primary 5 Primary 6

  • Primary 1
  • Primary 2
  • Primary 3
  • Primary 4
  • Primary 5
  • Primary 6

• name of non-formal school center?

• Learners’ NFL level

  Level 1

  Level 2

  level 3

  None

• have you attended a government/private school before?

  Yes

  No

  N/A

• what was the last grade you studied?

  Primary 1-3

  Primary 4-6

  Junior secondary

  Senior secondary

• What could be the reason you dropped out of school

  Select Lack of parental support Lack of school fees and Levy fee Domestic chores To make money for my family Other

  • Lack of parental support
  • Lack of school fees and Levy fee
  • Domestic chores
  • To make money for my family
  • Other

• Do you live with both parents?

  Yes

  No

  N/A

• who do you live with?

  Father only

  Mother Only

  Relatives

  Foster Parents

  I am head of household

• Are you involved in domestic house work/chores

  Yes

  No

  N/A

• does it interfere with your school hours or study time at home

  Yes

  No

  N/A

• which country are you displaced from?

• Are you living with any form of disability?

  Yes

  No

  N/A

• what type of disability do you have?

  Select Difficulty in seeing Difficulty in hearing Difficulty walking or climbing steps Difficulty in remembering and concentrating Difficulty in communicating or being understood Others

  • Difficulty in seeing
  • Difficulty in hearing
  • Difficulty walking or climbing steps
  • Difficulty in remembering and concentrating
  • Difficulty in communicating or being understood
  • Others

• Please specify

I am going to ask you some questions to test your reading and arithmetic skills. Feel free to stop at any point.

• Literacy Level

  Select Level 0 Level 1 Level 2 Level 3 Level 4 Level 5

  • Level 0
  • Level 1
  • Level 2
  • Level 3
  • Level 4
  • Level 5

• Numeracy Level

  Select Level 0 Level 1 Level 2 Level 3 Level 4 Level 5

  • Level 0
  • Level 1
  • Level 2
  • Level 3
  • Level 4
  • Level 5

• Respondent education category

  Formal School

  Non- Formal School

• name of school?

• Level

  Select Primary 1 Primary 2 Primary 3 Primary 4 Primary 5 Primary 6

  • Primary 1
  • Primary 2
  • Primary 3
  • Primary 4
  • Primary 5
  • Primary 6

• name of non-formal school center?

• Learners’ NFL level

  Level 1

  Level 2

  level 3

  None

• If out of school, have you attended a government/private school before?

  Yes

  No

  N/A

• what was the last grade you studied?

  Primary 1-3

  Primary 4-6

  Junior secondary

  Senior secondary

• What could be the reason you dropped out of school

  Select Lack of parental support Lack of school fees and Levy fee Domestic chores To make money for my family Other

  • Lack of parental support
  • Lack of school fees and Levy fee
  • Domestic chores
  • To make money for my family
  • Other

• Please specify

• Do you live with both parents?

  Yes

  No

  N/A

• who do you live with?

  Father only

  Mother Only

  Relatives

  Foster Parents

  I am head of household

• Are you involved in domestic house work/chores

  Yes

  No

  N/A

• does it interfere with your school hours or study time at home

  Yes

  No

  N/A