Chairperson - PAL) Network
Name of DistrictName of Village DevelopmentCommittee (As per CBS 2011)Ward NumberName of VillagesSurvey BookletName of Ward Citizen Forum(WCF) ChairpersonPhone Number of WCFChairpersonSurveyor’s NamePhone Numbers1.1.2.2.Master Trainers’ NamePhone NumberAddressDate of Survey1.2.Total Number of Household Surveyed:3.Yes NoWas this ward monitored?If YesName of the MonitorPhone NumberYes NoWas this ward rechecked?If YesName of the recheckerPhone Number
Map SheetDraw map of the ward here:First, draw a rough map in other paper. Once everyone agrees that the rough map is a good representation of the ward (village), and it matches with your experiences of walking around the whole village, then copy the map to this sheet.
Village Information SheetDistrict NameVDC NameWard #VillagesSurveyor’s Names1.2.SCHOOLSBASIC SERVICESDate of SurveyDay of SurveyDid you see the following services in the village?Please tick the relevant boxes (based on observation)Blacktopped road leading to the wardYESNOElectricity in the wardYESNOPost Office in the wardYESNOBank or cooperative in the ward?YESNOGovernment Primary Health Center in the village?YESNOPrivate medical shop in the village?YESNOComputer center/ internet cafe in the ward?YESNOEquipment/ facility using solar energy in the ward?YESNOGovernment Primary School (class 1-5) in the ward?YESNOGovernment Basic School (class 1-8) in the ward?YESNOGovernment Secondary School (class 1-10) in the ward?YESNOGovernment plus-two in the ward?YESNOPrivate School in the ward?YESNOPreschool (Early Childhood Development Center/Balsikshya/ Nursery/ LKG/ UKG) in the ward?YESNO
School Information SheetName of SchoolDistrict NameVDC NameWard #Surveyor’s NamesDate of Survey1.Day of Survey2.Arrival time in schoolType of school (tick)Primary (class 1-5)Children’s Enrollment andAttendanceBasic (class 1-8)Class 1Class 2Class 1-10Class 3Class 4RespondentNameDesignation(tick)Secondary (class 1-12)Class 5Class 6Class 7Contact InformationHead Master2.3.Classroom ObservationsFacilities ObservationTick the relevant boxClass 2YESIs there a blackboard/ whiteboard?If yes, could you write on theblackboard/ whiteboard?Are the desks modular?Did you see any other teachinglearning materials in the classroom?ClassroomWhere is thisVerandahclass seated?OutsideDid you see an office/ store?Class 4NOTeachersYESNONumberappointedNumberpresent today1. Head Master2. Permanent3. Governmentfunded other4. Niji Shrot1.Children’s attendancetoday(observe)School Ph. No.Mobile numberOfficial Medium of Instruction in the SchoolClass 8Children’s enrollment(from register)Are the students of this class sittingwith students from any other class?TeacherDid you see a playground?Did you see library books in the school?If yes, did you see library books being used by children?If there drinking water in the school?Do you see a complete boundary wall or fencing?Is there electricity connection in the school?If yes, was there electricity in the school today (observe/ask)Did you see computers for students to use?If yes, did you see students using computers?YesNo
Condition of ClassroomsClassroomsGoodNeedupgradeAny rooms unusable because of-UnusableEarthquakeFireFlood/landslideStormOther (mention)Total number of roomsTotal number of rooms used for Teaching?Continuous Assessment SystemToilets (by observation)Is there a toilet?TOILETSYesNoIf there is a toilet, is itlocked?YesNoIf unlocked, is it in usablecondition?YesNoGirlBoyCommonTeacherHave you heard about Continuous Assessment System (CAS) (ask)If yes,How many teachers in this school have received a Continuous Assessment System(CAS) manual or format? (ask)SomeIf manual or format was received, ask respondent to show it.Could you see a Continuous Assessment System (CAS) manual or format in the school?School Management Committee (SMC)Currently is there a School Management Committee for the School? (ask)YesNo/ /(dd/mm/yyyy)Was a SIP made for the current period?YesWhen was the SIP for the current five-year period made?Was the SIP for the current five-year period updated for this year?Baisakh- Chaitra 2072Did you get the grant?YesNoDon’tKnowBaisakh 2073 till date of surveyIf yes, did you spend the fullamount?Don’tYesNoKnowGirl child ScholarshipMarginalized studentScholarshipDalit ScholarshipDisabled students ScholarshipActivities Carried Out in the SchoolWhich of the following activities were carried out since April 2015? (Tickthe relevant box)CONSTRUCTION Construction of new classroomRepair of classrooms/ White wash/plasteringREPAIRRepair of drinking water facilityRepair of toiletsPurchase of furniturePURCHASEPurchase of sitting matsPurchase of teaching-learning materialsNoNoneDon’tKnowYesNoSchool Improvement Plan (SIP)If yes, then when was the last meeting of the SMC held?School GrantsAllYesSchool GrantsDid you get the grant?YesNoGirl child ScholarshipMarginalized studentScholarshipDalit ScholarshipDisabled students ScholarshipYesNoDon’tKnowDeparture time from schoolDon’tKnowIf yes, did you spend the fullamount?Don’tYesNoKnowNo/ /(dd/mm/yyyy)YesNo
Household Survey SheetWard #VillagesDate/ Day of Survey1.Full Name of familyhead2.For childrenage 3-6PreschoolIn-SchoolchildrenchildrenCannot sayCan sayCannot sayCan saySentenceWordSmall LetterCapital LetterDivisionSubtractionNumber Recognition (10-99)Number Recognition (1-9)BeginnerEnglishReading (highest Meaninglevel only)Word Sentence Mother’snameMath (highestlevel only)BeginnerParagraphSentenceWordNLetterYReading (highestlevel only)BeginnerNLanguage in which the child wastestedWhich sample was used to test?YDoes thechild goto thesurveyedschool?Cost per monthDoes thechildcurrentlytakepaidtuition?Basic Learning LevelsMedium of Instruction in schoolTuitionsYear dropped outDrop outNever enrolledOtherGrade dropped out inOut-of-SchoolchildrenPrivatePublicClassNot attendingPrivateECD (public)SexFather’s backgroundinformationFor children age 5-16NameofchildAgeTotal number of family membersthat eat from the same HHHamletName of RespondentSurveyor’s NamesS. No.Household #Has the Iffatheryeseverattendedschool?12345678Mother’s Background InformationS.No. Mother’sAge Has the If attendedNameMother school,everwhich classattended completed?School?Yes No1234Does anyone in the Household have amobile phone?YesNoMotorized2 wheeler(scooter,motorcycle,etc.)Motorized4 wheeler(car, jeep,etc.)YesYesNoNoIf yes, what is the mobilenumber?Household indicators (please tick the appropriate columns)ElectricityIf electricity Toilet in the TV in theIf TV inconnection inhouseholdhouseholdhousehold,(look orhousehold,is therewires andwas therecable esNoReading materials (otherthan textbooks)GetsOtherNewspaper (books,dailymagazines,religiousbooks, etc)YesNoYesNoHas anyone in the family completedSLC?*YesNoDon’t Know*Note: do not include mother(s) andfather(s) mentioned aboveDoes anyone in the HH know how touse a computer?YesNoStart time of surveyEnd time of surveyYNClass completed?VDC NameAgeDistrict Name
Household Survey SheetWard #VillagesDate/ Day of Survey1.Full Name of familyhead2.For childrenage 3-6PreschoolIn-SchoolchildrenchildrenCannot sayCan sayCannot sayCan saySentenceWordSmall LetterCapital LetterDivisionSubtractionNumber Recognition (10-99)Number Recognition (1-9)BeginnerEnglishReading (highest Meaninglevel only)Word Sentence Mother’snameMath (highestlevel only)BeginnerParagraphSentenceWordNLetterYReading (highestlevel only)BeginnerNLanguage in which the child wastestedWhich sample was used to test?YDoes thechild goto thesurveyedschool?Cost per monthDoes thechildcurrentlytakepaidtuition?Basic Learning LevelsMedium of Instruction in schoolTuitionsYear dropped outDrop outNever enrolledOtherGrade dropped out inOut-of-SchoolchildrenPrivatePublicClassNot attendingPrivateECD (public)SexFather’s backgroundinformationFor children age 5-16NameofchildAgeTotal number of family membersthat eat from the same HHHamletName of RespondentSurveyor’s NamesS. No.Household #Has the Iffatheryeseverattendedschool?12345678Mother’s Background InformationS.No. Mother’sAge Has the If attendedNameMother school,everwhich classattended completed?School?Yes No1234Does anyone in the Household have amobile phone?YesNoMotorized2 wheeler(scooter,motorcycle,etc.)Motorized4 wheeler(car, jeep,etc.)YesYesNoNoIf yes, what is the mobilenumber?Household indicators (please tick the appropriate columns)ElectricityIf electricity Toilet in the TV in theIf TV inconnection inhouseholdhouseholdhousehold,(look orhousehold,is therewires andwas therecable esNoReading materials (otherthan textbooks)GetsOtherNewspaper (books,dailymagazines,religiousbooks, etc)YesNoYesNoHas anyone in the family completedSLC?*YesNoDon’t Know*Note: do not include mother(s) andfather(s) mentioned aboveDoes anyone in the HH know how touse a computer?YesNoStart time of surveyEnd time of surveyYNClass completed?VDC NameAgeDistrict Name
Household Survey SheetWard #VillagesDate/ Day of Survey1.Full Name of familyhead2.For childrenage 3-6PreschoolIn-SchoolchildrenchildrenCannot sayCan sayCannot sayCan saySentenceWordSmall LetterCapital LetterDivisionSubtractionNumber Recognition (10-99)Number Recognition (1-9)BeginnerEnglishReading (highest Meaninglevel only)Word Sentence Mother’snameMath (highestlevel only)BeginnerParagraphSentenceWordNLetterYReading (highestlevel only)BeginnerNLanguage in which the child wastestedWhich sample was used to test?YDoes thechild goto thesurveyedschool?Cost per monthDoes thechildcurrentlytakepaidtuition?Basic Learning LevelsMedium of Instruction in schoolTuitionsYear dropped outDrop outNever enrolledOtherGrade dropped out inOut-of-SchoolchildrenPrivatePublicClassNot attendingPrivateECD (public)SexFather’s backgroundinformationFor children age 5-16NameofchildAgeTotal number of family membersthat eat from the same HHHamletName of RespondentSurveyor’s NamesS. No.Household #Has the Iffatheryeseverattendedschool?12345678Mother’s Background InformationS.No. Mother’sAge Has the If attendedNameMother school,everwhich classattended completed?School?Yes No1234Does anyone in the Household have amobile phone?YesNoMotorized2 wheeler(scooter,motorcycle,etc.)Motorized4 wheeler(car, jeep,etc.)YesYesNoNoIf yes, what is the mobilenumber?Household indicators (please tick the appropriate columns)ElectricityIf electricity Toilet in the TV in theIf TV inconnection inhouseholdhouseholdhousehold,(look orhousehold,is therewires andwas therecable esNoReading materials (otherthan textbooks)GetsOtherNewspaper (books,dailymagazines,religiousbooks, etc)YesNoYesNoHas anyone in the family completedSLC?*YesNoDon’t Know*Note: do not include mother(s) andfather(s) mentioned aboveDoes anyone in the HH know how touse a computer?YesNoStart time of surveyEnd time of surveyYNClass completed?VDC NameAgeDistrict Name
Household Survey SheetWard #VillagesDate/ Day of Survey1.Full Name of familyhead2.For childrenage 3-6PreschoolIn-SchoolchildrenchildrenCannot sayCan sayCannot sayCan saySentenceWordSmall LetterCapital LetterDivisionSubtractionNumber Recognition (10-99)Number Recognition (1-9)BeginnerEnglishReading (highest Meaninglevel only)Word Sentence Mother’snameMath (highestlevel only)BeginnerParagraphSentenceWordNLetterYReading (highestlevel only)BeginnerNLanguage in which the child wastestedWhich sample was used to test?YDoes thechild goto thesurveyedschool?Cost per monthDoes thechildcurrentlytakepaidtuition?Basic Learning LevelsMedium of Instruction in schoolTuitionsYear dropped outDrop outNever enrolledOtherGrade dropped out inOut-of-SchoolchildrenPrivatePublicClassNot attendingPrivateECD (public)SexFather’s backgroundinformationFor children age 5-16NameofchildAgeTotal number of family membersthat eat from the same HHHamletName of RespondentSurveyor’s NamesS. No.Household #Has the Iffatheryeseverattendedschool?12345678Mother’s Background InformationS.No. Mother’sAge Has the If attendedNameMother school,everwhich classattended completed?School?Yes No1234Does anyone in the Household have amobile phone?YesNoMotorized2 wheeler(scooter,motorcycle,etc.)Motorized4 wheeler(car, jeep,etc.)YesYesNoNoIf yes, what is the mobilenumber?Household indicators (please tick the appropriate columns)ElectricityIf electricity Toilet in the TV in theIf TV inconnection inhouseholdhouseholdhousehold,(look orhousehold,is therewires andwas therecable esNoReading materials (otherthan textbooks)GetsOtherNewspaper (books,dailymagazines,religiousbooks, etc)YesNoYesNoHas anyone in the family completedSLC?*YesNoDon’t Know*Note: do not include mother(s) andfather(s) mentioned aboveDoes anyone in the HH know how touse a computer?YesNoStart time of surveyEnd time of surveyYNClass completed?VDC NameAgeDistrict Name
Household Survey SheetWard #VillagesDate/ Day of Survey1.Full Name of familyhead2.For childrenage 3-6PreschoolIn-SchoolchildrenchildrenCannot sayCan sayCannot sayCan saySentenceWordSmall LetterCapital LetterDivisionSubtractionNumber Recognition (10-99)Number Recognition (1-9)BeginnerEnglishReading (highest Meaninglevel only)Word Sentence Mother’snameMath (highestlevel only)BeginnerParagraphSentenceWordNLetterYReading (highestlevel only)BeginnerNLanguage in which the child wastestedWhich sample was used to test?YDoes thechild goto thesurveyedschool?Cost per monthDoes thechildcurrentlytakepaidtuition?Basic Learning LevelsMedium of Instruction in schoolTuitionsYear dropped outDrop outNever enrolledOtherGrade dropped out inOut-of-SchoolchildrenPrivatePublicClassNot attendingPrivateECD (public)SexFather’s backgroundinformationFor children age 5-16NameofchildAgeTotal number of family membersthat eat from the same HHHamletName of RespondentSurveyor’s NamesS. No.Household #Has the Iffatheryeseverattendedschool?12345678Mother’s Background InformationS.No. Mother’sAge Has the If attendedNameMother school,everwhich classattended completed?School?Yes No1234Does anyone in the Household have amobile phone?YesNoMotorized2 wheeler(scooter,motorcycle,etc.)Motorized4 wheeler(car, jeep,etc.)YesYesNoNoIf yes, what is the mobilenumber?Household indicators (please tick the appropriate columns)ElectricityIf electricity Toilet in the TV in theIf TV inconnection inhouseholdhouseholdhousehold,(look orhousehold,is therewires andwas therecable esNoReading materials (otherthan textbooks)GetsOtherNewspaper (books,dailymagazines,religiousbooks, etc)YesNoYesNoHas anyone in the family completedSLC?*YesNoDon’t Know*Note: do not include mother(s) andfather(s) mentioned aboveDoes anyone in the HH know how touse a computer?YesNoStart time of surveyEnd time of surveyYNClass completed?VDC NameAgeDistrict Name
Household Survey SheetWard #VillagesDate/ Day of Survey1.Full Name of familyhead2.For childrenage 3-6PreschoolIn-SchoolchildrenchildrenCannot sayCan sayCannot sayCan saySentenceWordSmall LetterCapital LetterDivisionSubtractionNumber Recognition (10-99)Number Recognition (1-9)BeginnerEnglishReading (highest Meaninglevel only)Word Sentence Mother’snameMath (highestlevel only)BeginnerParagraphSentenceWordNLetterYReading (highestlevel only)BeginnerNLanguage in which the child wastestedWhich sample was used to test?YDoes thechild goto thesurveyedschool?Cost per monthDoes thechildcurrentlytakepaidtuition?Basic Learning LevelsMedium of Instruction in schoolTuitionsYear dropped outDrop outNever enrolledOtherGrade dropped out inOut-of-SchoolchildrenPrivatePublicClassNot attendingPrivateECD (public)SexFather’s backgroundinformationFor children age 5-16NameofchildAgeTotal number of family membersthat eat from the same HHHamletName of RespondentSurveyor’s NamesS. No.Household #Has the Iffatheryeseverattendedschool?12345678Mother’s Background InformationS.No. Mother’sAge Has the If attendedNameMother school,everwhich classattended completed?School?Yes No1234Does anyone in the Household have amobile phone?YesNoMotorized2 wheeler(scooter,motorcycle,etc.)Motorized4 wheeler(car, jeep,etc.)YesYesNoNoIf yes, what is the mobilenumber?Household indicators (please tick the appropriate columns)ElectricityIf electricity Toilet in the TV in theIf TV inconnection inhouseholdhouseholdhousehold,(look orhousehold,is therewires andwas therecable esNoReading materials (otherthan textbooks)GetsOtherNewspaper (books,dailymagazines,religiousbooks, etc)YesNoYesNoHas anyone in the family completedSLC?*YesNoDon’t Know*Note: do not include mother(s) andfather(s) mentioned aboveDoes anyone in the HH know how touse a computer?YesNoStart time of surveyEnd time of surveyYNClass completed?VDC NameAgeDistrict Name
Household Survey SheetWard #VillagesDate/ Day of Survey1.Full Name of familyhead2.For childrenage 3-6PreschoolIn-SchoolchildrenchildrenCannot sayCan sayCannot sayCan saySentenceWordSmall LetterCapital LetterDivisionSubtractionNumber Recognition (10-99)Number Recognition (1-9)BeginnerEnglishReading (highest Meaninglevel only)Word Sentence Mother’snameMath (highestlevel only)BeginnerParagraphSentenceWordNLetterYReading (highestlevel only)BeginnerNLanguage in which the child wastestedWhich sample was used to test?YDoes thechild goto thesurveyedschool?Cost per monthDoes thechildcurrentlytakepaidtuition?Basic Learning LevelsMedium of Instruction in schoolTuitionsYear dropped outDrop outNever enrolledOtherGrade dropped out inOut-of-SchoolchildrenPrivatePublicClassNot attendingPrivateECD (public)SexFather’s backgroundinformationFor children age 5-16NameofchildAgeTotal number of family membersthat eat from the same HHHamletName of RespondentSurveyor’s NamesS. No.Household #Has the Iffatheryeseverattendedschool?12345678Mother’s Background InformationS.No. Mother’sAge Has the If attendedNameMother school,everwhich classattended completed?School?Yes No1234Does anyone in the Household have amobile phone?YesNoMotorized2 wheeler(scooter,motorcycle,etc.)Motorized4 wheeler(car, jeep,etc.)YesYesNoNoIf yes, what is the mobilenumber?Household indicators (please tick the appropriate columns)ElectricityIf electricity Toilet in the TV in theIf TV inconnection inhouseholdhouseholdhousehold,(look orhousehold,is therewires andwas therecable esNoReading materials (otherthan textbooks)GetsOtherNewspaper (books,dailymagazines,religiousbooks, etc)YesNoYesNoHas anyone in the family completedSLC?*YesNoDon’t Know*Note: do not include mother(s) andfather(s) mentioned aboveDoes anyone in the HH know how touse a computer?YesNoStart time of surveyEnd time of surveyYNClass completed?VDC NameAgeDistrict Name
Household Survey SheetWard #VillagesDate/ Day of Survey1.Full Name of familyhead2.For childrenage 3-6PreschoolIn-SchoolchildrenchildrenCannot sayCan sayCannot sayCan saySentenceWordSmall LetterCapital LetterDivisionSubtractionNumber Recognition (10-99)Number Recognition (1-9)BeginnerEnglishReading (highest Meaninglevel only)Word Sentence Mother’snameMath (highestlevel only)BeginnerParagraphSentenceWordNLetterYReading (highestlevel only)BeginnerNLanguage in which the child wastestedWhich sample was used to test?YDoes thechild goto thesurveyedschool?Cost per monthDoes thechildcurrentlytakepaidtuition?Basic Learning LevelsMedium of Instruction in schoolTuitionsYear dropped outDrop outNever enrolledOtherGrade dropped out inOut-of-SchoolchildrenPrivatePublicClassNot attendingPrivateECD (public)SexFather’s backgroundinformationFor children age 5-16NameofchildAgeTotal number of family membersthat eat from the same HHHamletName of RespondentSurveyor’s NamesS. No.Household #Has the Iffatheryeseverattendedschool?12345678Mother’s Background InformationS.No. Mother’sAge Has the If attendedNameMother school,everwhich classattended completed?School?Yes No1234Does anyone in the Household have amobile phone?Yes
Map Sheet Draw map of the ward here: First, draw a rough map in other paper. Once everyone agrees that the rough map is a good representation of the ward (village), and it matches with your experiences of walking around the whole village, then copy the map to this sheet.
Club e-Book – Service Chairperson July 28, 2017 Back to Table of Contents 4 Welcome to the Club Service Chairperson e-Book! This guide is designed to support you in your role as the service chairperson for your club. It contains tools and resources for you to be successful not only in your individual role, but as a cohesive team member with
The responsibilities for the running of the Board and the Company are distinct tasks. The roles of Chairperson and CEO shall be separate with a clear division of responsibilities. 10.1 Role of the Chairperson The Board should elect a Chairperson who can provide the direction necessary for an effective Board. The Chairperson
GC PAL / PAL GC-xt User Manual Installation and Operation Electrical Hazards Every analytical instrument has specific hazards, so be sure to read and comply with the following precautions. They will help ensure the safe, long-term use of your PAL System. The installation category
Alex M. Allman, Vice Chairperson Louise LeTendre, Chairperson Kenneth R. Avery, Treasurer Dwayne R. Adams Board of Trustees FY 2015 (from left) Dwayne R. Adams Sarah Casper-Woodhead Taryn J. Martin Kenneth R. Avery, Treasurer Susan H. Hazlett, Vice Chairperson Nancy A. Brown Mary Hastler, CEO Bruce M. Smith Alex
Chairperson: Donielle Dziedzic, A. Duie Pyle Staff Liaison: Jacob Pierce, American Trucking Associations 9:00 AM – 10:15 AM: Welcoming Remarks (Room 231 – 234) SMC National Chairperson: Lisa Gonnerman, Transport America TSC National Chairperson: Mark Landry, Fed
1 UNIVERSITY OF DAYTON - 170th COMMENCEMENT BOARD OF TRUSTEES Mary H. Boosalis Chairperson Rev. Oscar Vasquez, S.M. 1st Vice Chairperson Richard J. Omlor 2nd Vice Chairperson Catherine V. Babington
Dr. Rajiv Singh Controller of Examination Dr. Lakhwinder Singh Training & Placement Officer Dr. Anju Gupta Chairperson, Women Cell Dr. Vikas Turk Chief Hostel Warden Dr. Sanjeev Goyal Principal,Community College Director, Alumni and Corporate Affairs Dr. Poonam Singhal Chairperson (EL) Dr. Neelam Turk Chairperson (EE) 0129-2310108 0129-2310172 .
A: From the Regions and Zones page, scroll to the zone where the chairperson will be assigned. (Note: the chairperson can only be assigned to one person at a time. When the role has not been assigned, the Zone Chairperson's name will be displayed as "(vacant!)". When the role has already been assigned to another person, the term
