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1. Map2. Village Information Sheet3. School Observation Sheet4. Household Survey Sheet5. Village Compilation Sheet

Surveyors’ names: Phone number: Postal address:1.

Date of survey:Total number ofhouseholdssurveyed:

Master Trainers’ names: Phone number:1.2.

SURVEYBOOKLET

If yesName of the Monitor:Phone number:

Was this villagemonitored?

Yes No

If yesName of the Rechecker:Phone number:

Was this villagerechecked?

Yes No

Name of state:

Name of district:

Name of village:

Name of Sarpanch/Village representative:

Phone number of Sarpanch/Villagerepresentative:

Table of Contents

INSTRUCTIONS TO DRAW THE MAP• Show the different hamlets/sections of the surveyed village.

• Number each hamlet/section on the map.

• Show the main landmarks – schools, health centres, anganwadis, temples, mosques, river,road, bus stop, panchayat bhavan, shop etc.

• Verify all the information on the map with people in the village as you walk around.

Mark the main roads/streets/paths through the village prominently on the map.

MAP OF THE VILLAGE:

Day of survey:

Surveyors' names:2 .

Date of survey:

Did you see the following facilities/services in the village yourself?

(Tick Yes/No based on your own observation)

YES NO

Name of state:

Name of district:

Name of block:

Name of village:

VILLAGE INFORMATION SHEET

Please tick () the relevant box

Pucca road leading to the village?

YES NO

Govt. Upper-primary School (Std. 1 to 7/8) in th ill ?

Private health clinic in the village? YES

Govt. Primary/Sub Health Centre in the village?

Post office in the village?

Govt. Ration/PDS shop in the village?

Equipment/facility using solar energy (private/public) in the village?

Computer centre/internet café in the village?

Govt. Primary School (Std. 1 to 4/5) in the village?

YES NO

Electricity connection in the village?

YES NO

Bank (any type) in the village? YES

YES NO

the village?

Private school in the village?

Govt. School (Std. 6 to 8/10/12) in the village? YES

Pre-school (Anganwadi/Balwadi/LKG/UKG/Nursery) in the village?

Govt. Secondary School (Std. 1 to 10) in the village?

YES NO

ASER 2014 - SCHOOLOBSERVATION SHEET

From which Std. to which Std.?(tick any one) Surveyors’ names

Arrival time inschool

INSTRUCTIONS: Visit any government school (Std. 1 to 7/8) in the village. If there is no school in the village which has classes from Std. 1 to 7/8, then visit the government schoolin the village which has the highest enrollment in Std. 1 to 4/5. Do not visit a government school if it has no classes from Std. 1 to 4/5. If there is no government school in thevillage with classes from Std. 1 to 4/5 then do not visit any school. Meet the Head Master (in the absence of the HM, meet the senior most teacher) of the school.Documents required: Register with enrollment details of children.

Std.1 to 6/7/81 to 4/5

Std.Others

Date ofsurvey

Name of school: Name of village:

District: State:Block:

NameRespondent information

Phone number

Designation(Tick) HM Teacher

Day ofsurvey

*Note: Take a headcount of children present. If more than one class is seated together, ask thechildren of each class to raise their hands separately and then count accordingly. If more than 1section, do headcount in all sections and write the total.

2. OFFICIALMEDIUM OF

INSTRUCTION INTHE SCHOOL

1. CHILDREN’S ENROLLMENTAND ATTENDANCE

Children’s enrollment (Take fromregister yourself). If more than 1section, write the total.

Std.1 Std.2 Std.3 Std.4 Std.5 Std.6 Std.7 Std.8

Children’s attendance today*

Total number of pucca rooms in the school excluding toilets (countyourself and write)

Did you see a handpump/tap?

If there is no handpump/tap or it is not usable, did you seedrinking water available?

Total number of rooms being used for teaching today (count yourself and write)Yes NoTick the relevant box

If there is a handpump/tap, could you use it to drink water?

Did you see a complete boundary wall or fencing?

6. FACILITIES OBSERVATION

Did you see an office/store/office-cum store?Did you see a playground?

Did you see library books in the school?If yes, did you see library books being used/read by children?

If yes, did you see children using computers?

Did you see computers to be used by children in the school?

5. MID-DAY MEAL

Yes NoTick the relevant box

Did you see food being cooked inthe school? (Observe)

Is there a kitchen/shed forcooking mid-day meal?(Observe)

Was mid-day meal served in theschool today? (Ask)

Did you see any evidence of themeal being served to the childrentoday (Look for evidence like dirtyutensils or meal brought fromoutside)? (Observe)

4. CLASSROOM OBSERVATIONS

Are the children of this Std. sittingwith children from any other Std.?

Std. 2

Yes Std. 4

No Yes No

Is there a blackboard for this class?

Apart from textbooks, did you see anyother TLM (e.g. other books, charts onthe wall, board games etc.) in theroom?

Observe(If more than 1 section, choose any 1)

If yes, could you easily write on theblackboard?

Tick the relevant box

Where is the classseated?(tick one)

ClassroomVerandahOutdoor

3. TEACHERSNumber

appointed(Ask)

Numberpresent

(Observe)

Head Master (Do not include acting HM)

Regular Govt. Teachers (Do not include HeadMaster)

Para-teachers

11. SCHOOL GRANT INFORMATION (SSA) (Ask the HM. If the HM is absent, then ask the senior most teacher)

HM Para-teacherRegular TeacherWho gave theinformation aboutgrants? (tick any one) Yes No Don’t

Does the school have 2 or more SSApassbooks?

Note: If there is more than 1 toilet of a particular type, then take information ofthe toilet in a better condition.

Departure time from school

12B. ACTIVITIES CARRIED OUT IN SCHOOLWhich of the following activities were undertaken since April 2013?(Tick the relevant box)

Yes No Don’tknow

Construction Construction of new classroom(s)

Repair Repair of drinking water facility

Repair of toilet

White wash/plastering

Purchase of sitting mats/Tat PattiPurchase

Purchase of charts, globes or otherteaching material

Was a School Development Plan (SDP) made for your schoolin 2013-14? (Ask) (Do not include DISE format as SDP)

If yes, then when was the last meeting of theSchool Management Committee (SMC) held?(Ask)

Yes No

How many members attended the last meeting? (Ask andwrite the number)

9. SCHOOL MANAGEMENT COMMITTEE (SMC)

If yes, then could you see the School Development Planyourself? (Ask and observe)

—— —— ———(dd/mm/yyyy)

Currently is there a School Management Committee (SMC)for this school? (Ask) Yes No

Yes No

Did you get thegrant?

If yes,did you spendthe full amount?

SchoolMaintenanceGrant (SMG)

12A. SSA ANNUALSCHOOL GRANTNote: If there are 2separate HMs withseparate SSA bankaccounts, please takethe information forStd.1 to 4/5

April 2013 to March 2014

SchoolDevelopmentGrant (SDG)

Don’tknow NoYes Don’t

New ClassroomGrant

Teacher Grant (TLM)(for all teachers)

Did you get thegrant?

If yes,did you spendthe full amount?

SchoolMaintenanceGrant (SMG)

Note: If there are 2separate HMs withseparate SSA bankaccounts, pleasetake the informationfor Std.1 to 4/5

April 2014 to Date of Survey

SchoolDevelopmentGrant (SDG)

Don’tknow NoYes Don’t

New ClassroomGrant

Teacher Grant (TLM)(for all teachers)

7. TOILETS (by observation)

Toilets

GirlBoy

CommonTeacher

Is there atoilet?

If there is a toilet, wasit locked?

If unlocked, was it ina usable condition?

Yes No Locked Unlocked Yes No

Have you heard about Continuous and ComprehensiveEvaluation/CCE? (Ask)

Could you see a Continuous and Comprehensive Evaluationmanual or format in the school? (Ask and observe)

All Some None Don’tknow

How many teachers in this school have received aContinuous and Comprehensive Evaluation manualor format? (Ask)

Yes No

If yes,

Yes No

If manual or format was received, ask the respondent to show it

8. CONTINUOUS AND COMPREHENSIVE EVALUATION (CCE)

10. SCHOOL DEVELOPMENT PLAN (SDP)

State: ___________________ District: _____________________ Block: _________________ Village: ___________________Se

rial n

Mother's name

Full name of family head

12345678

HH No.Total number of members in theHH who eat from the samekitchen

Mother's name Ag

MOTHER'S BACKGROUND INFORMATIONIf attendedschool, thenwhich Std.

completed?

Has the motherever attended

school?Sl.no.

For age 5-16

HOUSEHOLD INDICATORS (Tick the appropriate column)

Type of housePucca

(with wallsand roof ofbrick andcement)

Kutcha SemiKutcha

Electricityconnection

(Look forwires andfittings)

Yes No

If electricity inhousehold,was thereelectricity

today?

Yes No

Toilet inthe

household

Yes No

TV in thehousehold

Yes No

If TV inhousehold,

is therecable TV?

(paid facility)

Yes No

Reading material(other than school textbooks )

Getsnewspaperdaily (Ask)

Yes No

Other (Books,magazine, religious

books etc.)

Does anyone in theHH know how to use

a computer?

Yes No

Name of child(Children age 3-16

regularly living in thehousehold) A

ge Sex

In school children(Currently enrolled

in school)(Age 5-16)

Out of schoolchildren

(Currently notenrolled in school)

(Age 5-16)

Drop out

Pre-schoolchildren

(Age 3-6)

For age3-6Child information

(for age 3-16)

Motorised2-wheeler (Motorcycle/ scooter)

Yes No

ASER 2014 - HOUSEHOLD SURVEY SHEET

Basic Learning Level(Test all children between the ages of 5-16 only)

Reading( the highest

level ONLY)

End time of survey

Does anyone in the household have a mobilephone? Yes No If yes, what is the mobile number?

Father'sbackgroundinformation

If Yes

Tuitions

Math( the highest

level ONLY)

Has anyone in theHH completed 12th

Yes No Don'tknow

Respondent name

Hamlet/section no.(from the map) and/or name of hamlet/section

Surveyors' names:Date of survey

Start time of survey

Day of survey1.

Yes No

*Do not include theabove mentionedmother(s) and father(s).

For age 5-16

English( the highest level ONLY)

ll let

Reading

MeaningWord Sentence

rial n

Mother's name

12345678

Mother's name Ag

completed?

school?Sl.no.

For age 5-16

Type of housePucca

Kutcha SemiKutcha

Yes No

today?

Yes No

Toilet inthe

household

Yes No

TV in thehousehold

Yes No

If TV inhousehold,

is therecable TV?

(paid facility)

Yes No

books etc.)

a computer?

Yes No

ge Sex

(Age 5-16)

Drop out

Pre-schoolchildren

(Age 3-6)

(for age 3-16)

Yes No

level ONLY)

End time of survey

If Yes

Tuitions

Math( the highest

level ONLY)

Yes No Don'tknow

Respondent name

Day of survey1.

Yes No

For age 5-16

ll let

Reading

rial n

Mother's name

12345678

Mother's name Ag

completed?

school?Sl.no.

For age 5-16

Type of housePucca

Kutcha SemiKutcha

Yes No

today?

Yes No

Toilet inthe

household

Yes No

TV in thehousehold

Yes No

If TV inhousehold,

is therecable TV?

(paid facility)

Yes No

books etc.)

a computer?

Yes No

ge Sex

(Age 5-16)

Drop out

Pre-schoolchildren

(Age 3-6)

(for age 3-16)

Yes No

level ONLY)

End time of survey

If Yes

Tuitions

Math( the highest

level ONLY)

Yes No Don'tknow

Respondent name

Day of survey1.

Yes No

For age 5-16

ll let

Reading

rial n

Mother's name

12345678

Mother's name Ag

completed?

school?Sl.no.

For age 5-16

Type of housePucca

Kutcha SemiKutcha

Yes No

today?

Yes No

Toilet inthe

household

Yes No

TV in thehousehold

Yes No

If TV inhousehold,

is therecable TV?

(paid facility)

Yes No

books etc.)

a computer?

Yes No

ge Sex

(Age 5-16)

Drop out

Pre-schoolchildren

(Age 3-6)

(for age 3-16)

Yes No

level ONLY)

End time of survey

If Yes

Tuitions

Math( the highest

level ONLY)

Yes No Don'tknow

Respondent name

Day of survey1.

Yes No

For age 5-16

ll let

Reading

rial n

Mother's name

12345678

Mother's name Ag

completed?

school?Sl.no.

For age 5-16

Type of housePucca

Kutcha SemiKutcha

Yes No

today?

Yes No

Toilet inthe

household

Yes No

TV in thehousehold

Yes No

If TV inhousehold,

is therecable TV?

(paid facility)

Yes No

books etc.)

a computer?

Yes No

ge Sex

(Age 5-16)

Drop out

Pre-schoolchildren

(Age 3-6)

(for age 3-16)

Yes No

level ONLY)

End time of survey

If Yes

Tuitions

Math( the highest

level ONLY)

Yes No Don'tknow

Respondent name

Day of survey1.

Yes No

For age 5-16

ll let

Reading

rial n

Mother's name

12345678

Mother's name Ag

completed?

school?Sl.no.

For age 5-16

Type of housePucca

Kutcha SemiKutcha

Yes No

today?

Yes No

Toilet inthe

household

Yes No

TV in thehousehold

Yes No

If TV inhousehold,

is therecable TV?

(paid facility)

Yes No

books etc.)

a computer?

Yes No

ge Sex

(Age 5-16)

Drop out

Pre-schoolchildren

(Age 3-6)

(for age 3-16)

Yes No

level ONLY)

End time of survey

If Yes

Tuitions

Math( the highest

level ONLY)

Yes No Don'tknow

Respondent name

Day of survey1.

Yes No

For age 5-16

ll let

Reading

rial n

Mother's name

12345678

Mother's name Ag

completed?

school?Sl.no.

For age 5-16

Type of housePucca

Kutcha SemiKutcha

Yes No

today?

Yes No

Toilet inthe

household

Yes No

TV in thehousehold

Yes No

If TV inhousehold,

is therecable TV?

(paid facility)

Yes No

books etc.)

a computer?

Yes No

ge Sex

(Age 5-16)

Drop out

Pre-schoolchildren

(Age 3-6)

(for age 3-16)

Yes No

level ONLY)

End time of survey

If Yes

Tuitions

Math( the highest

level ONLY)

Yes No Don'tknow

Respondent name

Day of survey1.

Yes No

For age 5-16

ll let

Reading

rial n

Mother's name

12345678

Mother's name Ag

completed?

school?Sl.no.

For age 5-16

Type of housePucca

Kutcha SemiKutcha

Yes No

today?

Yes No

Toilet inthe

household

Yes No

TV in thehousehold

Yes No

If TV inhousehold,

is therecable TV?

(paid facility)

Yes No

books etc.)

a computer?

Yes No

ge Sex

(Age 5-16)

Drop out

Pre-schoolchildren

(Age 3-6)

(for age 3-16)

Yes No

level ONLY)

End time of survey

If Yes

Tuitions

Math( the highest

level ONLY)

Yes No Don'tknow

Respondent name

Day of survey1.

Yes No

For age 5-16

ll let

Reading

rial n

Mother's name

12345678

Mother's name Ag

completed?

school?Sl.no.

For age 5-16

Type of housePucca

Kutcha SemiKutcha

Yes No

today?

Yes No

Toilet inthe

household

Yes No

TV in thehousehold

Yes No

If TV inhousehold,

is therecable TV?

(paid facility)

Yes No

books etc.)

a computer?

Yes No

ge Sex

(Age 5-16)

Drop out

Pre-schoolchildren

(Age 3-6)

(for age 3-16)

Yes No

level ONLY)

End time of survey

If Yes

Tuitions

Math( the highest

level ONLY)

Yes No Don'tknow

Respondent name

Day of survey1.

Yes No

For age 5-16

ll let

Reading

rial n

Mother's name

12345678

Mother's name Ag

completed?

school?Sl.no.

For age 5-16

Type of housePucca

Kutcha SemiKutcha

Yes No

today?

Yes No

Toilet inthe

household

Yes No

TV in thehousehold

Yes No

If TV inhousehold,

is therecable TV?

(paid facility)

Yes No

books etc.)

a computer?

Yes No

ge Sex

(Age 5-16)

Drop out

Pre-schoolchildren

(Age 3-6)

(for age 3-16)

Yes No

level ONLY)

End time of survey

If Yes

Tuitions

Math( the highest

level ONLY)

Yes No Don'tknow

Respondent name

Day of survey1.

Yes No

For age 5-16

ll let

Reading

rial n

Mother's name

12345678

Mother's name Ag

completed?

school?Sl.no.

For age 5-16

Type of housePucca

Kutcha SemiKutcha

Yes No

today?

Yes No

Toilet inthe

household

Yes No

TV in thehousehold

Yes No

If TV inhousehold,

is therecable TV?

(paid facility)

Yes No

books etc.)

a computer?

Yes No

ge Sex

(Age 5-16)

Drop out

Pre-schoolchildren

(Age 3-6)

(for age 3-16)

Yes No

level ONLY)

End time of survey

If Yes

Tuitions

Math( the highest

level ONLY)

Yes No Don'tknow

Respondent name

Day of survey1.

Yes No

For age 5-16

ll let

Reading

rial n

Mother's name

12345678

Mother's name Ag

completed?

school?Sl.no.

For age 5-16

Type of housePucca

Kutcha SemiKutcha

Yes No

today?

Yes No

Toilet inthe

household

Yes No

TV in thehousehold

Yes No

If TV inhousehold,

is therecable TV?

(paid facility)

Yes No

books etc.)

a computer?

Yes No

ge Sex

(Age 5-16)

Drop out

Pre-schoolchildren

(Age 3-6)

(for age 3-16)

Yes No

level ONLY)

End time of survey

If Yes

Tuitions

Math( the highest

level ONLY)

Yes No Don'tknow

Respondent name

Day of survey1.

Yes No

For age 5-16

ll let

Reading

rial n

Mother's name

12345678

Mother's name Ag

completed?

school?Sl.no.

For age 5-16

Type of housePucca

Kutcha SemiKutcha

Yes No

today?

Yes No

Toilet inthe

household

Yes No

TV in thehousehold

Yes No

If TV inhousehold,

is therecable TV?

(paid facility)

Yes No

books etc.)

a computer?

Yes No

ge Sex

(Age 5-16)

Drop out

Pre-schoolchildren

(Age 3-6)

(for age 3-16)

Yes No

level ONLY)

End time of survey

If Yes

Tuitions

Math( the highest

level ONLY)

Yes No Don'tknow

Respondent name

Day of survey1.

Yes No

For age 5-16

ll let

Reading

rial n

Mother's name

12345678

Mother's name Ag

completed?

school?Sl.no.

For age 5-16

Type of housePucca

Kutcha SemiKutcha

Yes No

today?

Yes No

Toilet inthe

household

Yes No

TV in thehousehold

Yes No

If TV inhousehold,

is therecable TV?

(paid facility)

Yes No

books etc.)

a computer?

Yes No

ge Sex

(Age 5-16)

Drop out

Pre-schoolchildren

(Age 3-6)

(for age 3-16)

Yes No

level ONLY)

End time of survey

If Yes

Tuitions

Math( the highest

level ONLY)

Yes No Don'tknow

Respondent name

Day of survey1.

Yes No

For age 5-16

ll let

Reading

rial n

Mother's name

12345678

Mother's name Ag

completed?

school?Sl.no.

For age 5-16

Type of housePucca

Kutcha SemiKutcha

Yes No

today?

Yes No

Toilet inthe

household

Yes No

TV in thehousehold

Yes No

If TV inhousehold,

is therecable TV?

(paid facility)

Yes No

books etc.)

a computer?

Yes No

ge Sex

(Age 5-16)

Drop out

Pre-schoolchildren

(Age 3-6)

(for age 3-16)

Yes No

level ONLY)

End time of survey

If Yes

Tuitions

Math( the highest

level ONLY)

Yes No Don'tknow

Respondent name

Day of survey1.

Yes No

For age 5-16

ll let

Reading

rial n

Mother's name

12345678

Mother's name Ag

completed?

school?Sl.no.

For age 5-16

Type of housePucca

Kutcha SemiKutcha

Yes No

today?

Yes No

Toilet inthe

household

Yes No

TV in thehousehold

Yes No

If TV inhousehold,

is therecable TV?

(paid facility)

Yes No

books etc.)

a computer?

Yes No

ge Sex

(Age 5-16)

Drop out

Pre-schoolchildren

(Age 3-6)

(for age 3-16)

Yes No

level ONLY)

End time of survey

If Yes

Tuitions

Math( the highest

level ONLY)

Yes No Don'tknow

Respondent name

Day of survey1.

Yes No

For age 5-16

ll let

Reading

rial n

Mother's name

12345678

Mother's name Ag

completed?

school?Sl.no.

For age 5-16

Type of housePucca

Kutcha SemiKutcha

Yes No

today?

Yes No

Toilet inthe

household

Yes No

TV in thehousehold

Yes No

If TV inhousehold,

is therecable TV?

(paid facility)

Yes No

books etc.)

a computer?

Yes No

ge Sex

(Age 5-16)

Drop out

Pre-schoolchildren

(Age 3-6)

(for age 3-16)

Yes No

level ONLY)

End time of survey

If Yes

Tuitions

Math( the highest

level ONLY)

Yes No Don'tknow

Respondent name

Day of survey1.

Yes No

For age 5-16

ll let

Reading

rial n

Mother's name

12345678

Mother's name Ag

completed?

school?Sl.no.

For age 5-16

Type of housePucca

Kutcha SemiKutcha

Yes No

today?

Yes No

Toilet inthe

household

Yes No

TV in thehousehold

Yes No

If TV inhousehold,

is therecable TV?

(paid facility)

Yes No

books etc.)

a computer?

Yes No

ge Sex

(Age 5-16)

Drop out

Pre-schoolchildren

(Age 3-6)

(for age 3-16)

Yes No

level ONLY)

End time of survey

If Yes

Tuitions

Math( the highest

level ONLY)

Yes No Don'tknow

Respondent name

Day of survey1.

Yes No

For age 5-16

ll let

Reading

rial n

Mother's name

12345678

Mother's name Ag

completed?

school?Sl.no.

For age 5-16

Type of housePucca

Kutcha SemiKutcha

Yes No

today?

Yes No

Toilet inthe

household

Yes No

TV in thehousehold

Yes No

If TV inhousehold,

is therecable TV?

(paid facility)

Yes No

books etc.)

a computer?

Yes No

ge Sex

(Age 5-16)

Drop out

Pre-schoolchildren

(Age 3-6)

(for age 3-16)

Yes No

level ONLY)

End time of survey

If Yes

Tuitions

Math( the highest

level ONLY)

Yes No Don'tknow

Respondent name

Day of survey1.

Yes No

For age 5-16

ll let

Reading

rial n

Mother's name

12345678

Mother's name Ag

completed?

school?Sl.no.

For age 5-16

Type of housePucca

Kutcha SemiKutcha

Yes No

today?

Yes No

Toilet inthe

household

Yes No

TV in thehousehold

Yes No

If TV inhousehold,

is therecable TV?

(paid facility)

Yes No

books etc.)

a computer?

Yes No

ge Sex

(Age 5-16)

Drop out

Pre-schoolchildren

(Age 3-6)

(for age 3-16)

Yes No

level ONLY)

End time of survey

If Yes

Tuitions

Math( the highest

level ONLY)

Yes No Don'tknow

Respondent name

Day of survey1.

Yes No

For age 5-16

ll let

Reading

rial n

Mother's name

12345678

Mother's name Ag

completed?

school?Sl.no.

For age 5-16

Type of housePucca

Kutcha SemiKutcha

Yes No

today?

Yes No

Toilet inthe

household

Yes No

TV in thehousehold

Yes No

If TV inhousehold,

is therecable TV?

(paid facility)

Yes No

books etc.)

a computer?

Yes No

ge Sex

(Age 5-16)

Drop out

Pre-schoolchildren

(Age 3-6)

(for age 3-16)

Yes No

level ONLY)

End time of survey

If Yes

Tuitions

Math( the highest

level ONLY)

Yes No Don'tknow

Respondent name

Day of survey1.

Yes No

For age 5-16

ll let

Reading

rial n

Mother's name

12345678

Mother's name Ag

completed?

school?Sl.no.

For age 5-16

Type of housePucca

Kutcha SemiKutcha

Yes No

today?

Yes No

Toilet inthe

household

Yes No

TV in thehousehold

Yes No

If TV inhousehold,

is therecable TV?

(paid facility)

Yes No

books etc.)

a computer?

Yes No

ge Sex

(Age 5-16)

Drop out

Pre-schoolchildren

(Age 3-6)

(for age 3-16)

Yes No

level ONLY)

End time of survey

If Yes

Tuitions

Math( the highest

level ONLY)

Yes No Don'tknow

Respondent name

Day of survey1.

Yes No

For age 5-16

ll let

Reading

rial n

Mother's name

12345678

Mother's name Ag

completed?

school?Sl.no.

For age 5-16

Type of housePucca

Kutcha SemiKutcha

Yes No

today?

Yes No

Toilet inthe

household

Yes No

TV in thehousehold

Yes No

If TV inhousehold,

is therecable TV?

(paid facility)

Yes No

books etc.)

a computer?

Yes No

ge Sex

(Age 5-16)

Drop out

Pre-schoolchildren

(Age 3-6)

(for age 3-16)

Yes No

level ONLY)

End time of survey

If Yes

Tuitions

Math( the highest

level ONLY)

Yes No Don'tknow

Respondent name

Day of survey1.

Yes No

For age 5-16

ll let

Reading

rial n

Mother's name

12345678

Mother's name Ag

completed?

school?Sl.no.

For age 5-16

Type of housePucca

Kutcha SemiKutcha

Yes No

today?

Yes No

Toilet inthe

household

Yes No

TV in thehousehold

Yes No

If TV inhousehold,

is therecable TV?

(paid facility)

Yes No

books etc.)

a computer?

Yes No

ge Sex

(Age 5-16)

Drop out

Pre-schoolchildren

(Age 3-6)

(for age 3-16)

Yes No

level ONLY)

End time of survey

If Yes

Tuitions

Math( the highest

level ONLY)

Yes No Don'tknow

Respondent name

Day of survey1.

Yes No

For age 5-16

ll let

Reading

ASER 2014 - VILLAGE COMPILATION SHEET

Write total numbers in relevant boxes.One row for each household is given.

Name of state:

Name of disrtict:

Name of block:

Name of village:

Generalinformation

r of H

Number ofsurveyed

children in theHH

Number of children andtheir schooling status

Anganwadi orPre-school

status

Schooling status

Out ofschool

children(currently

notenrolled)

Number of children tested

Reading

If the number ofhouseholds

surveyed in the villageis less than 20, givereasons in this box.

Basic Learning Levels

Total numberof locked

households

Total number of‘No Response’

households

English

ReadingMeaning

Sentence

141516

Did you remember the following during the survey?

1 Have you filled in all the information on the cover page, including the Sarpanch's name and phone number?

2 Have you written the name and phone number of the respondent in the school?

3 Have you numbered the hamlets/sections on the map, and do they correspond to the section numbers filled in the household survey sheets? Haveyou also written the HH No. on each household survey sheet?

4 Have you written the name of the respondent, name of family head and phone number for every surveyed household in the household survey sheet?

5 Have you recorded the gender and age of each surveyed child?

6 Have you ticked the schooling status of each surveyed child?

If the child is enrolled in school, have you written what class the child is in?7

Surveyed children in the age group 5-16 years must be tested. Have you tested all of them? If not, have you written the reason behind the householdsurvey sheet?

During testing, did you make children solve arithmetic problems (subtraction/division) on the back of the household survey sheet?9

Have you marked the highest learning level for each child in all the testing columns (Reading/Math/English)?10