Title Page

  • Site conducted

  • Conducted on

  • Prepared by

  • Name of the interviewer / enumerator

  • Name of the State

  • Name of the LGA

  • Name of the Village

  • Location

Untitled Page

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

Thank the respondent unwillingness to participate.

Household Questions (These section questions will be asked from the households heads or any household member who is willing to respond )

  • What is your name?

  • Gender

  • Are you the head of the household?

  • who is the head of your household

  • Age

  • Marital status

  • Are you living with any disability?

  • State your highest level of education?

  • Please specify

  • What is the total number of family members living in your household?

  • Total number of male members (inclusive of children and all elders who are resident of this house)

  • Total number of female members (inclusive of children and all elders who are resident of this house)

  • How many children are of age between 6 – 12 years in your HH?

  • How many male children from 6-12 years in you HH?

  • How many female children from 6-12 years in you HH?

  • How many children are of age between 13-18 years in HH?

  • How many male children are of age between 13-18 years in HH?

  • How many female children are of age between 13-18 years in HH?

  • Do you have any disabled child in your house?

  • How many of the children with disability are aged between 6-18 years?

  • can you please provide detail of the type of disability?

  • How many of the children in this house are currently going to school?

  • How many children in this house are out-of-school?

  • What is the reason(s) of those children being out of school?

  • Please specify

  • Do you think education is a necessity for children?

  • Can you please explain the reason of your response?

  • Do you support your child(ren) in learning, if needed?

  • If you do support your child(ren), what kind of support do you provide? Choose multiple

  • please specify

  • Are you able to give the support in learning/education, if your child is facing a disability?

  • If you do support your child(ren) living with a disability in learning, what kind of support do you provide? (choose multiple)

  • What language do you speak most frequently at home?

  • Please specify

  • Do you have the following items at your home? (check all that apply)

  • Displacement Status

  • What is your main source of income?

Children /Adolescent Questions (These section questions will be asked to the out of school and non-formal school students/ children / adolescent within age bracket 6 years to 18 years. In case child/ adolescent is not available or unwilling to respond due to shyness or any other factor, parent of that child/adolescent respondent or any other family member can respond)

  • Name of the Child/ Adolescent Respondent

  • Gender

  • Age

  • Are there books, newspapers or other materials for you to read at home?

  • Using your usual language, do you have difficulty communicating, for example, understanding or being understood?

  • Do you attend school currently?

  • what type of school do you attend?

  • What is the name of your school/ learning center?

  • Learners’ NFL education level [Conduct ASER Assessment]

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

  • what was the last grade you studied?

  • How long have you been out-of-school?

  • What could be the reason you dropped out of school?

  • Please specify

  • Does someone at home read to you or help with homework?

  • who reads to you at home?

  • Do you live with both parents?

  • who do you live with?

  • Are you involved in domestic house work/chores?

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

  • Do you have water at your home?

  • Do you have washroom/ toilet in your home?

  • Do you have water in your learning center?

  • What is the water in your learning centre used for?

  • Do you have a toilet in your learning centre?

  • How many toilets are there in your learning centre?

  • Are the toilets separate for girls and boys?

  • Are the toilets separate for children/ learners and teachers?

  • Where do you use a toilet during school day?

  • Please specify

  • Did you wash your hand the last time you used a toilet/latrine in school?

  • why? mention the reason

  • Why do you think it’s important to wash hands?

  • Do you know the critical times to wash your hands?

  • can you mention them? [mark all options the child mentions]

  • How many times you wash your hands in a day?

  • For which of the following, do you wash your hands? (choose multiple)

  • please specify

  • Do you wash your hands with soap?

  • How often do you wash your hands with soaps after using toilet?

Section 1: Household Questions<br>These section questions will be asked from the households heads or any household member who is willing to respond

  • 1. What is your name?

  • 2. Gender

  • 3. Are you the head of the household?

  • if not, then who is the head of your household?

  • 4. Age

  • 5. Marital Status

  • 6. Are you living with disability?

  • 7. State your highest level of education?

Family members living in your household

  • 8. Total number of family members living in your household?

  • 9. Total number of male members (inclusive of children and all elders who are resident of this house)

  • 10. Total number of female members (inclusive of children and all elders who are resident of this house)

Children of age 6-12 years in your household

  • 11. How many children in total are of age between 6 – 12 years in your Household?

  • 12. How many male children are of age between 6 – 12 years in your HH?

  • 13. How many female children are of age between 6 – 12 years in your HH?

Children of age 13-18 years in your household

  • 14. How many children in total are of age between 13– 18 years in your Household?

  • 15. How many male children in total are of age between 13– 18 years in your Household?

  • 16. How many female children in total are of age between 13– 18 years in your Household?

  • 17. Do you have any disabled child(ren) in your house

  • How many of these children are under age between 6-18 years?

  • Can you please provide detail of the type of disability?

  • 18. How many of the children in this house are currently going to school?

  • 19. Are there any out of children in this house?

  • How many children in this house are out-of-school?

  • What is the reason(s) of those children being out of school?

  • Please specify

  • 20. Do you think education is a necessity for children?

  • 21. Can you please explain the reason of your response?

  • 22. Do you support your child(ren) in learning, if needed?

  • 23. If you do support your child(ren), what kind of support do you provide? (choose multiple)

  • 24. Are you able to give the support in learning/education, if your child is facing a disability?

  • 25. If you do support your child(ren) living with a disability in learning, what kind of support do you provide?

  • 26. What language do you speak most frequently at home?

  • Please specify

  • 27. Do you have the following items at your home?

  • 28. Displacement Status

  • 29. What is your main source of income?

Section 2: Children /Adolescent Questions<br>These section questions will be asked to the out of school and non-formal school students/ children / adolescent within age bracket 6 years to 18 years. In case child/ adolescent is not available or unwilling to respond due to shyness or any other factor, parent of that child/adolescent respondent or any other family member can respond<br>

Child 1

  • 1. Name of the Child/ Adolescent Respondent

  • 2. Gender

  • 3. Age

  • 4. Are there books, newspapers or other materials for you to read at home?

  • 5 .Using your usual language, do you have difficulty communicating, for example, understanding or being understood?

  • 6. Do you live with both parents?

  • If no, who do you live with?

  • 7. Do you attend any non-formal school currently?

  • 7.1 What is name of your school / learning center?

  • 7.2. Learners’ NFL education level

Literacy Level

  • Level 1

  • Level 2

  • Level 3

  • None

Numeracy Level

  • Level 1

  • Level 2

  • Level 3

  • Level 4

  • Level 5

  • Level 6

  • None

  • 7.3 Does someone at home read to you or help with homework?

  • If yes, who reads to you at home?

  • 7.4 Are you involved in domestic house work/chores?

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

  • 7.5 Do you have water in your learning center?

  • 7.6 What is the water in your learning center used for?

  • 7.7 Do you have a toilet in your learning centre?

  • 7.8 How many toilets are there in your learning center?

  • 7.9 Are the toilets separate for girls and boys?

  • 7.10 Are the toilets separate for children/ learners and teachers?

  • 7.11 Where do you use a toilet during school day?

  • Specify

  • 7.12 Did you wash your hand the last time you used a toilet/latrine in school?

  • If no, why?

  • What is the reason you think it’s important to wash hands?

  • 7.1 If out of school, have you attended any school before?

  • 7.2 What type of school did you attend previously?

  • Specify?

  • 7.3 What was the last grade you studied?

7.4 How long have you been out of school?

  • Years

  • Months

  • 7.5 What were the reason you dropped out of school?

  • Please specify

  • 7.6 Are you involved in domestic house work / chores?

  • 8. Do you have water at your home?

  • 9. Do you have washroom/ toilet in your home?

  • 10. Do you think it is important to wash hands?

  • 10.1 What is the reason you think it is important to to wash hands?

  • 11. Do you know the critical times to wash your hands?

  • If yes, can you mention them? [mark all options the child mentions]

  • 12. How many times you wash your hand in a day

  • 13. For which of the following, do you wash your hands?

  • Please specify?

  • 14. Do you wash your hands with soap?

  • 15. How often do you wash your hands with soaps after using toilet?

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