CTC Household Survey

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Name of the interviewer / enumerator

• Name of the State

  Adamawa

  Borno

  Yobe

• Name of the LGA

• Name of the Village

• Location
  Address

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

  Yes

  No

  N/A

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

  Male

  Female

• Are you the head of the household?

  Yes

  No

  N/A

• who is the head of your household

  Male

  Female

• Age

  Select Less than 15 years 15 – 29 years 30 – 45 years 46 – 60 years 60 -75 years Above 75 years

  • Less than 15 years
  • 15 – 29 years
  • 30 – 45 years
  • 46 – 60 years
  • 60 -75 years
  • Above 75 years

• Marital status

  Single

  Married

  Widowed

  Divorced

• Are you living with any disability?

  Yes

  No

  N/A

• State your highest level of education?

  Select Illiterate Junior Primary Senior Primary Matric College level (FSC) NCE, BA Ed, BSc Ed, BA, PGDE MA, MA Ed, MSc, MSc Ed Islamic education Technical education Others

  • Illiterate
  • Junior Primary
  • Senior Primary
  • Matric
  • College level (FSC)
  • NCE, BA Ed, BSc Ed, BA, PGDE
  • MA, MA Ed, MSc, MSc Ed
  • Islamic education
  • Technical education
  • Others

• 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?

  Yes

  No

  N/A

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

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

  Select Visual impairment Hearing Impairment Speech impairment Mental and Cognitive Impairment Physical Impairment

  • Visual impairment
  • Hearing Impairment
  • Speech impairment
  • Mental and Cognitive Impairment
  • Physical Impairment

• 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?

  Select Child(ren) has a disability Financial limitations No interest in education Child(ren) is married/ will be married soon Prefer religious education over formal education No educational facilities available The child works to earn a living for the HH Security Issue Others

  • Child(ren) has a disability
  • Financial limitations
  • No interest in education
  • Child(ren) is married/ will be married soon
  • Prefer religious education over formal education
  • No educational facilities available
  • The child works to earn a living for the HH
  • Security Issue
  • Others

• Please specify

• Do you think education is a necessity for children?

  Yes

  No

  N/A

• Can you please explain the reason of your response?

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

  Yes

  No

  N/A

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

  Select I read to my child(ren). I help with homework. I take extra jobs/ work to support the education of my child(ren). I advocate for education of child(ren) in my community. Other

  • I read to my child(ren).
  • I help with homework.
  • I take extra jobs/ work to support the education of my child(ren).
  • I advocate for education of child(ren) in my community.
  • Other

• please specify

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

  Yes

  No

  N/A

• 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?

  Select English Hausa Kanuri Fulfulde Shuwa Others

  • English
  • Hausa
  • Kanuri
  • Fulfulde
  • Shuwa
  • Others

• Please specify

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

  Radio

  Television

  Internet

  Computer

  Mobile Phone

• Displacement Status

  Select IDP (in Camp) IDP (living among host community) Host Community Returnee Refugee

  • IDP (in Camp)
  • IDP (living among host community)
  • Host Community
  • Returnee
  • Refugee

• 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

  Male

  Female

• Age

  Select 6 Years 7 Years 8 Years 9 Year 10 Year 11 Year 12 Year 13 Year 14 Year 15 Year 16 Year 17 Year 18 Year

  • 6 Years
  • 7 Years
  • 8 Years
  • 9 Year
  • 10 Year
  • 11 Year
  • 12 Year
  • 13 Year
  • 14 Year
  • 15 Year
  • 16 Year
  • 17 Year
  • 18 Year

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

  Yes

  No

  N/A

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

  No difficulty

  Some difficulty

  A lot of difficulty

  Cannot do at all

• Do you attend school currently?

  Yes

  No

  N/A

• what type of school do you attend?

  Formal school

  Non-formal school

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

• Learners’ NFL education level [Conduct ASER Assessment]

  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

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

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

  Select Lack of parental support Lack of financial resource to educate Distance to school To make money for my family Domestic chores Resistance of parent Other

  • Lack of parental support
  • Lack of financial resource to educate
  • Distance to school
  • To make money for my family
  • Domestic chores
  • Resistance of parent
  • Other

• Please specify

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

  Yes

  No

  N/A

• who reads to you at home?

  Mother

  Father

  Older Brother

  Older sister

  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

• Do you have water at your home?

  Yes

  No

  N/A

• Do you have washroom/ toilet in your home?

  Yes

  No

  N/A

• Do you have water in your learning center?

  Yes

  No

  N/A

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

  Drinking

  Washing hands

  Cleaning

  Other

• Do you have a toilet in your learning centre?

  Yes

  No

  N/A

• How many toilets are there in your learning centre?

  One

  Two

  Three

  Four

• Are the toilets separate for girls and boys?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Where do you use a toilet during school day?

  In school

  At home

  In the bush

  In neighboring school

  Other

• Please specify

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• why? mention the reason

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

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

  Yes

  No

  N/A

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

  Select Before preparing food/cooking Before eating Before feeding a child After using a latrine After changing a child diaper or washing his faeces After taking care of sick person I don’t know

  • Before preparing food/cooking
  • Before eating
  • Before feeding a child
  • After using a latrine
  • After changing a child diaper or washing his faeces
  • After taking care of sick person
  • I don’t know

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

  Select 1 2 3 4 5 6 More than6

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • More than6

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

  Select Before preparing food/cooking Before eating Before feeding a child After using a latrine After changing a child diaper or washing his faeces Others

  • Before preparing food/cooking
  • Before eating
  • Before feeding a child
  • After using a latrine
  • After changing a child diaper or washing his faeces
  • Others

• please specify

• Do you wash your hands with soap?

  Yes

  No

  N/A

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

  Select 1 2 3 4 5 6 More than6

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • More than6