Title Page

  • Site conducted

  • Conducted on

  • Prepared by

  • Location
  • State

  • L.G.A

  • Ward

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

  • - Note the respondent unwillingness to proceed

  • 1. What is enumerator name?

  • 2. Enumerator Gender

  • 3. What is respondent's name?

  • 4. Respondent's Gender

  • 5. Age

  • 6. Displacement Status

  • Specify as appropriate

  • Which country are you displaced from?

  • 7. Are you living with any form of disability?

  • 7.1 What type of disability do you have?

  • Specify

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

8. Literacy Level

  • Level 3: Sentences<br>Ask the child to read all the sentences aloud. Can the child read all the sentences easily and without stopping? Does the child has three mistakes or fewer. It is okay, if child reads slowly

  • Level 4: Text (Short story)<br>Ask the child to read all the sentences aloud. Can the child read all the sentences easily and without stopping? Does the child has three mistakes or fewer. It is okay, if child reads slowly

  • Mark child at level 3

  • Level 5: Questions and text comprehensions<br>Ask the child to read all the sentences aloud. Can the child read all the sentences easily and without stopping? Does the child has three mistakes or fewer. It is okay, if child reads slowly

  • Select Level 4

  • Level 6: Text (long story and comprehension)<br>Ask the child to read all the sentences aloud. Can the child read all the sentences easily and without stopping? Does the child has three mistakes or fewer. It is okay, if child reads slowly

  • Mark child at Level 6

  • Mark child at Level 5

  • Level 2: Words<br>Ask the child to read all the sentences aloud. Can the child read all the sentences easily and without stopping? Does the child has three mistakes or fewer. It is okay, if child reads slowly

  • Level 1: Letters<br>Ask the child to read all the sentences aloud. Can the child read all the sentences easily and without stopping? Does the child has three mistakes or fewer. It is okay, if child reads slowly

  • Mark child at Level 1

  • Mark child at Level 0

  • Mark child at Level 2

9. Numeracy Level

  • Level 3: Addition and Subtraction<br>Ask the child to choose and solve 5 problems one by one. If the child doesn't choose problem, you can choose. The child can use paper and pencil to solve the problem. Did the child solve 4 of 5 problems correctly?

  • Level 4: Multiplication and Division<br>Ask the child to choose and solve 5 problems one by one. If the child doesn't choose problem, you can choose. The child can use paper and pencil to solve the problem. Did the child solve 4 of 5 problems correctly?

  • Mark child at Level 3

  • Level 5: Word Problem<br>Ask the child to choose and solve 5 problems one by one. If the child doesn't choose problem, you can choose. The child can use paper and pencil to solve the problem. Did the child solve problems correctly?

  • Level 6: Word Problem<br>Ask the child to choose and solve 5 problems one by one. If the child doesn't choose problem, you can choose. The child can use paper and pencil to solve the problem. Did the child solve problems correctly?

  • Mark Child at Level 6

  • Mark Child at Level 5

  • Mark child at Level 4

  • Level 2: 2-digit numbers<br>Ask the child to choose and solve 5 problems one by one. If the child doesn't choose problem, you can choose. The child can use paper and pencil to solve the problem. Did the child solve 4 of 5 problems correctly?

  • Mark child at Level 2

  • Level 1: 1-digit numbers<br>Ask the child to choose and solve 5 problems one by one. If the child doesn't choose problem, you can choose. The child can use paper and pencil to solve the problem. Did the child solve 4 of 5 problems correctly?

  • Mark child at Level 1

  • Mark child at Level 0

  • 10. Respondent's education

  • Name of school

  • Level

  • Name of school

  • Level

  • 11. Have you ever been out of school?

  • At the time you were dropped out of school. what was the last grade you studied?

  • What was the reason you dropped out of school?

  • Specify

  • 12. Do you live with both parents?

  • If no, who do you live with?

  • 13. Are you involved in domestic house work/ chores?

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

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.