ABCDEFGHIJKLMNOPQRSTUVWXYZ
1
ANNEX 1A School-Community Data Template
2
3
I. SCHOOL PROFILE/DATA
4
5
Instruction: Please input required data/information in unshaded cells. Fill-in only the grade levels that are applicable to your school. This template aims to organize existing school and community data from different sources. If you find it useful to lift data from other templates and transfer it here, you may do so. Otherwise, you can just attach the other data templates to this form.
6
7
8
9
IDENTIFYING INFORMATION
10
School ID: ____________________________________
Name of School: ______________________________________
11
Address: _____________________________________
Barangay: ___________________________________________
12
District: _____________________________________Municipality: ________________________________________
13
Division: ____________________________________Region: ____________________________________________
14
15
A. GEOGRAPHY
16
A.1 Location of the School. Check the appropriate description.
17
18
19
20
A.2 Relative Distance of the School
Distance in kmMode of Transportation
21
22
 a. From the poblacion
23
 b. From the nearest public elementary school
24
 c. From the nearest private elementary school
25
 d. From the nearest public secondary school
26
 e. From the nearest private secondary school
27
 f. From the District Office
28
 g. From the Division Office
29
30
A.3 Incidence of crimes and other human-induced hazards
31
A.3.1 Check if there have been incidences of the following in the last 3 years.
32
33
34
35
36
37
38
39
40
41
42
43
44
A.3.2 What are the 3 most frequent crimes/human-induced hazards?
45
1st most frequent: _________________________________
46
2nd most frequent: _________________________________
47
3rd most frequent: _________________________________
48
49
A.4 Incidence of natural hazards
50
A.4.1 Check if there have been incidences of the following in the last 3 years.
51
52
53
54
55
56
57
A.4.2 What are the 3 most frequent natural hazards?
58
1st most frequent: _________________________________
59
2nd most frequent: _________________________________
60
3rd most frequent: _________________________________
61
62
A.5 Result of disaster incidents
63
64
65
66
B. LEARNING ENVIRONMENT
67
B.1 Classrooms and seats
68
B.1.1 Classroom quantity [SRC.15.]
69
LevelTotal Enrollment, Current SYNo. of Classrooms
70
In Good ConditionFor Repair/ RehabilitationTotalLearner:classroom ratio 1
71
Kindergarten
72
Grade 1
73
Grade 2
74
Grade 3
75
Grade 4
76
Grade 5
77
Grade 6
78
Grade 7
79
Grade 8
80
Grade 9
81
Grade 10
82
Grade 11
83
Grade 12
84
TOTAL
85
1 Learner:classroom ratio = Total enrollment divided by the total number of classrooms
86
87
B.1.2 Classroom seat quantity [SRC.17.] Indicate the total number of seats in all classrooms.
88
NumberLearner:seat ratio 2
89
90
2 Learner:seat ratio = Total enrollment divided by the total number of seats
91
92
B.2 Water, Sanitation and Hygiene (WASH) facilities
93
B.2.1 Water supply/source. Check as appropriate.
94
95
96
Is the main source of water functional at present?
97
Pls. cite reasons why: ______________________________________________
98
99
B.2.2 Handwashing. Is there space for handwashing?
100
If YES: