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Student Template 3 -Form Fill

School Information
Q01

What is the name of the school?

Q02

What is the school code?

Q03

What is the programme code?
Q04

What is the school category?
Q05

What are the school timings?
Q06

What is the type of the school?
Q07

Name of the village/ Urban Local Body (ULB)
Q08

Code of the district
Q09

Code of the block
Q10

Date of interview
Q11

Time of interview

Q12

Name of the investigator
Q13

Investigator code
Student Information
A01

New or existing student?
A01A

What is your name?
A02

What is the student’s gender?
A03

How old are you?
A04

Which class/grade does the student study in?
A05

What is the student’s roll number in the class?
A06

Serial number of the student
A07

Unique Identification (UID) number of the student
A08

What caste do you belong to?
A09

Which religion do you follow?
A10

Who earns the most money in your household?
A11

How long does it take for you to get to school?
A12

Do you have anyone at home to help you with studies?
A13

Do you take extra lessons after school (tuitions)?
A14

How many friends do you have in school?
A15

How often do you meet your friends outside school (to play or for studying/tuitions etc)
A16

Does your school have an Aflatoun club?
A17

Are you a part of the Aflatoun club in your school?
A18

What is your role in the Aflatoun club?
A19

How frequently did the Aflatoun facilitators/teachers come to your school in the last 6 months?
A20

In the last month, how many times did you miss the Aflatoun club meeting?
A21

In the last month, how many times the Aflatoun facilitators/teachers did not visit when they were supposed to visit for training?
A22

How much time did the Aflatoun facilitators/teachers spend with you and the group when they visited last time?
A23

What topics did the like the most during the Aflatoun club meetings?
A24

Do you have an Aflatoun Passbook?
A25

What is the amount saved by the child in the last week?
A26

What is the amount saved by the child in total?
A27

On a scale of 1 to 5, how much do you like the Aflatoun program?
Student’s Knowledge on Rights and Responsibilities
B01

Are you aware of the four main rights for children?
B02

Can you name the main rights for children?
B03

Do you think the child rights are applicable equally to both boys and girls?
B04

Are you aware of your civic responsibilities?
B05

What are the civic responsibilities that you should practice?
B06

Are you aware of your environmental duties?
B07

What are some of the environmental duties that you should practice?
B08

What are some of the practices to keep the environment clean in our daily life?
Student’s Self and Inter-personal Skills
C01

I like going to school everyday
C02

I feel nervous while answering questions in a class
C03

I would argue with a friend about an issue that he or she has a very different opinion about
C04

If a person has a disability, it is not acceptable to be friends with him or her
C05

If a person has HIV AIDS, it is not acceptable to be friends with him or her
C06

If a person is from another religion, it is not acceptable to be friends with him/her
C07

If a person is from another caste, it is not acceptable to be friends with him/her
C08

“I am going to ask you some questions on yourself and I would like you to respond in one of the three following ways

C08_1

I take a positive attitude toward myself
C08_2

I certainly feel useless at times
C08_3

At times I think I am no good at all
C08_4

Children pick on me very often
C09

Have you been picked on by other students inside or outside the school in the past 6 months?
C10

You are doing a great job. Now I am going to read a statement to you, and you to have to decide how much confidence you have that this statement describes you well.

C10_1

I can always manage to solve difficult problems if I try hard enough
C10_2

If someone opposes me, I can find the means and ways to get what I want.
C10_3

It is easy for me to stick to my aims and accomplish my goals.
C10_4

I am confident that I could deal efficiently with unexpected events
C10_5

Thanks to my resourcefulness, I know how to handle unforeseen situations.
C10_6

I can solve most problems if I invest the necessary effort.
C10_7

I can remain calm when facing difficulties because I can rely on my coping abilities
C10_8

When I am confronted with a problem, I can usually find several solutions
C10_9

If I am in trouble, I can usually think of a solution
C10_10

I can usually handle whatever comes my way
C11

“You are doing a great job. Now I am going to read a statement to you, and I want you to find out about how you think and feel about them.

C11_1

I feel sorry for other children who don’t have toys and clothes
C11_2

It makes me sad to see a child who can’t find anyone to play with
C11_3

I can tell by looking at a person, whether they are happy
C11_4

When I see someone being picked on, I feel kind of sorry for them
C11_5

I notice straight away when something makes my best friend unhappy
C11_6

I feel sorry for people who don’t have the things that I have
C12

“You are doing a great job. Now I am going to read a statement to you, and I want to find out about how you think and feel about them.

C12_1

I think I am doing pretty well
C12_2

When I have a problem, I can come up with lots of ways to solve it
C12_3

Even when others want to quit, I know that I can find ways to solve the problem
C13

“You are doing a great job. Now I am going to read a statement to you, and I want to find out about how you think and feel about them. For each statement I read, I want you to let me know whether the statement is applicable to YOU using a scale of 1 to 7, where (01) is NOT AT ALL and (07) is A LOT, and (98) is Don’t Know. Let us start.”

C13_1

How much are you thinking about yourself right now?
C13_2

How much are you thinking about others right now?
C13_3

To what extent do you feel close to family?
C14

“Please rate the extent to which you feel close to your family. For example, if you choose figure 1, it means that you do not feel close at all. If you choose figure 7, it means that you are extremely close to your family.”

C14_1

Please rate the extent to which you feel close to your family?
Student’s Participation in Social and Classroom Activities
D01

Have you participated in any classroom activity in the last month?
D02

What was the activity that you participated in the classroom?
D03

Have you participated in any social group activity/occasion outside or inside the school premises, in the last one month?
D04

What was the activity/occasion that you participated?
D05

Imagine you are given a task in the classroom (not homework; but activity like cooking lunch for everyone in your class). Would you ask for help from your friends or would you do it alone?
D06

Why would you not ask for help?
D07

What do you want to be when you grow up?
Student’s Financial Literacy and Awareness
E01

What are the different methods for saving money that you are aware of?
E02

What work does a bank do?
E03

What is the age limit for opening a bank account?
E04

What documents do you need to open a bank account?
E05

What are the different types of bank account?
E06

If we go to a bank, and ask them for the money to something that we cannot afford, what is that called?
E07

If we have some money left over after paying for all expenses, and we want to increase the left-over money by giving it to the bank, what is that called?
E08

Do you make a budget of your expenses before you spend money?
E09

How often are you able to spend according to the budget you made?
E10

“Now I am going to read some questions regarding your access to money in the past few days. You can take your time answer these questions. The answers you give will not be reported to your teacher, friends or anyone else in your family. Let us start.”

E10_1

How much money did you get in the last 7 days? This can be money that you worked for. It is okay to estimate or give a rough figure.
E10_2

In the past four months, did you work or complete tasks and chores, either inside or outside of your household, to earn money?
E10_3

Is some or all of money you earn yours to keep or do you give it to your household?
E11

“I want to ask you about the primary work you do inside or outside of the household to earn money.”

E11A

How much money earned in direct payment for completing activity in past 30 days?

E11A_1

Personal agriculture/animal husbandry product for market
E11A_2

Subsistence agriculture/animal husbandry product
E11A_3

Other product for market
E11A_4

Agricultural/ animal husbandry wage labour outside home
E11A_5

Self-owned retailer
E11A_6

Other self-owned enterprise
E11A_7

Salaried position in a shop/enterprise
E11A_8

Wage labour for contract
E11A_9

Casual wage labour
E11A_10

Renting land/ money-lending
E11A_11

Household chores
E11B

In the past 30 days, how many days did you do this activity?

E11B_1

Personal agriculture/animal husbandry product for market
E11B_2

Subsistence agriculture/animal husbandry product
E11B_3

Other product for market
E11B_4

Agricultural/ animal husbandry wage labour outside home
E11B_5

Self-owned retailer
E11B_6

Other self-owned enterprise
E11B_7

Salaried position in a shop/enterprise
E11B_8

Wage labour for contract
E11B_9

Casual wage labour
E11B_10

Renting land/ money-lending
E11B_11

Household chores
E12

“Now I am going to read some questions regarding your expenditure behaviour in the past few days. You can take your time answer these questions. The answers you give will not be reported to your teacher, friends or anyone else in your family. Let us start.”

E12_1

How much money did you spend on yourself in the last 7 days? This can be any money you will have. It is okay to estimate.
E12_2

how much money did you spend on snacks (Biscuits, chocolates, soft drinks etc). It is okay to estimate.
E12_3

how much money did you spend on non-food goods or activities for personal use (toys etc). It is okay to estimate.
E13

“I would like to ask how you would spend a certain amount of money. Imagine that I give you 100 Rupees right now. You can use it anyway that you want. How would you use it and how much would you use for each thing that you choose to use it for? Let us start.”

E13_1

School fees/ materials
E13_2

Necessary food or household items
E13_3

Health-related costs for me or another person
E13_4

Enjoyment (such as snacks, non-necessary clothing items, toys, movies etc.)
E13_5

Gift for another person (or group/organization)
E13_6

Give it to temple/mosque/religious place
E13_7

Short-term saving (such as “keep it with me in case I want or need to buy something soon”)
E13_8

Save for emergencies
E13_9

Long-term saving (such as “save for the future”)
E13A

Amount of money

E13A_1

School fees/ materials
E13A_2

Necessary food or household items
E13A_3

Health-related costs for me or another person
E13A_4

Enjoyment (such as snacks, non-necessary clothing items, toys, movies etc.)
E13A_5

Gift for another person (or group/organization)
E13A_6

Give it to temple/mosque/religious place
E13A_7

Short-term saving (such as “keep it with me in case I want or need to buy something soon”)
E13A_8

Save for emergencies
E13A_9

Long-term saving (such as “save for the future”)
E14

To what extent is savings an important goal for you?
E15

Did you have any specific goal in mind, when you were saving money?
E16

If you had a specific goal, could you tell me about the goal?
E17

To what extent will you feel guilty if you spend money from your savings?
E18

In a month, how many times are you able to save money for yourself?
E19

Do you have any money saved right now, either with a friend, or a group, or a money box or at the bank etc?
E20

How much money have you saved in the previous month?
E21

How much money have saved in total?
E22

Where do you save your money most often?
E23

How much money did you save last week?
E24

Do you ever save money with friends in order to buy something together?
E25

Would someone in your household be angry or upset if they found out that you were saving for yourself?
E26

Please rank the following ways to save by how safe you think they are.

E26_1

With friend
E26_2

With bank
E26_3

With money box
E26_4

With family member
E26_5

Using personal Passbook
E26_6

With a club
E27

Do you have savings account in a bank?
E28

How many times have you used your savings account to save money in the past six months?
E29

Have you ever been to a bank?
E30

“Now I am going to read some statements about saving preferences.

E30_1

Saving for something for longer than a month is too difficult
E30_2

Saving money is not necessary if you live at home with your family
E30_3

Saving money is only for parents to do
E31

Choose between 2 Gifts today versus 2 Gifts in one week

E32

Choose between 2 Gifts today versus 3 gifts in one week
E33

Choose between 2 Gifts today versus 4 Gifts in one week

E34

Choose between 2 Gifts today versus 5 Gifts in one week

E35

Choose between 2 Gifts today versus 6 Gifts in one week

E36

Choose between 2 Gifts today versus 7 Gifts in one week

E37

Choose between 2 Gifts today versus 8 Gifts in one week

E38

Choose between 2 Gifts today versus 9 Gifts in one week

E39

Choose between 2 Gifts today versus 10 Gifts in one week

E40

Choose between 2 Gifts in one week versus 2 Gifts in two weeks
E41

Choose between 2 Gifts in one week versus 3 Gifts in two weeks
E42

Choose between 2 Gifts in one week versus 4 Gifts in two weeks
E43

Choose between 2 Gifts in one week versus 5 Gifts in two weeks
E44

Choose between 2 Gifts in one week versus 6 Gifts in two weeks
E45

Choose between 2 Gifts in one week versus 7 Gifts in two weeks
E46

Choose between 2 Gifts in one week versus 8 Gifts in two weeks
E47

Choose between 2 Gifts in one week versus 9 Gifts in two weeks
E48

Choose between 2 Gifts in one week versus 10 Gifts in two weeks
E49

“I am the shopkeeper. You should know that I will only sell socks and shoes in pair, but I can sell you individual pencils. Tell me which item you want to buy and how much of each item. You must spend all your money. Once you buy something, you cannot give it back again.”

E49A

Allocation Item

E49A_1

Socks
E49A_2

Shoes
E49A_3

Pencils
E49A_4

Left over?
E49B

Units

E49B_1

Socks
E49B_2

Shoes
E49B_3

Pencils
E49B_4

Left over?
E49C

Money Allocated

E49C_1

Socks
E49C_2

Shoes
E49C_3

Pencils
E49C_4

Left over?
E50

“Let’s play another game. Imagine that your family is preparing meal for tonight, and you have 10 rupees to spend on food at the shop. There are only three items to buy: oil, rice and onions. Here is what each item costs -”

E50A

Allocation Item

E50A_1

Oil
E50A_2

Rice
E50A_3

Onions
E50A_4

Left over?
E50B

Units

E50B_1

Oil
E50B_2

Rice
E50B_3

Onions
E50B_4

Left over?
E50C

Money Allocated

E50C_1

Oil
E50C_2

Rice
E50C_3

Onions
E50C_4

Left over?
E51

How many seconds did it take the respondent to arrive at his or her allocation?
E52

Card version
E53

Record the number of statements the student agreed with
Annual Status of Education Report [ASER] Arithmetic knowledge
F01

Problem

F02

Selected for the exercise

F02_1

63-44 = ?
F02_2

51-35 = ?
F02_3

92-48 = ?
F02_4

71-35 = ?
F02_5

45-27 = ?
F02_6

84 – 57 = ?
F02_7

52 – 14 = ?
F02_8

66 – 48 = ?
F03

Student able to identify numbers

F03_1

63-44 = ?
F03_2

51-35 = ?
F03_3

92-48 = ?
F03_4

71-35 = ?
F03_5

45-27 = ?
F03_6

84 – 57 = ?
F03_7

52 – 14 = ?
F03_8

66 – 48 = ?
F04

Student able to identify subtraction sign

F04_1

63-44 = ?
F04_2

51-35 = ?
F04_3

92-48 = ?
F04_4

71-35 = ?
F04_5

45-27 = ?
F04_6

84 – 57 = ?
F04_7

52 – 14 = ?
F04_8

66 – 48 = ?
F05

Answer given by student

F05_1

63-44 = ?
F05_2

51-35 = ?
F05_3

92-48 = ?
F05_4

71-35 = ?
F05_5

45-27 = ?
F05_6

84 – 57 = ?
F05_7

52 – 14 = ?
F05_8

66 – 48 = ?
F06

Time taken by student to answer

F06_1

63-44 = ?
F06_2

51-35 = ?
F06_3

92-48 = ?
F06_4

71-35 = ?
F06_5

45-27 = ?
F06_6

84 – 57 = ?
F06_7

52 – 14 = ?
F06_8

66 – 48 = ?
F07

Correct answer

F07_1

63-44 = ?
F07_2

51-35 = ?
F07_3

92-48 = ?
F07_4

71-35 = ?
F07_5

45-27 = ?
F07_6

84 – 57 = ?
F07_7

52 – 14 = ?
F07_8

66 – 48 = ?
F08

Is the student’s answer correct?

F08_1

63-44 = ?
F08_2

51-35 = ?
F08_3

92-48 = ?
F08_4

71-35 = ?
F08_5

45-27 = ?
F08_6

84 – 57 = ?
F08_7

52 – 14 = ?
F08_8

66 – 48 = ?
F09

Is the student at subtraction level?
F10

Problem

F11

Selected for the exercise

F11_1

898/7 = ?
F11_2

659/4 = ?
F11_3

946/8 = ?
F11_4

757/6 = ?
F12

Answer given by student

F12_1

898/7 = ?
F12_2

659/4 = ?
F12_3

946/8 = ?
F12_4

757/6 = ?
F13

Time taken by student to answer

F13_1

898/7 = ?
F13_2

659/4 = ?
F13_3

946/8 = ?
F13_4

757/6 = ?
F14

Correct answer

F14_1

898/7 = ?
F14_2

659/4 = ?
F14_3

946/8 = ?
F14_4

757/6 = ?
F15

Is the student’s answer correct?

F15_1

898/7 = ?
F15_2

659/4 = ?
F15_3

946/8 = ?
F15_4

757/6 = ?
F16

Is the student at division level?
ASER Financial Awareness
G01

What was the time taken by the student to answer the question?
G02

For how many days from 1st May 2019 to 31 October 2019 (6 months) was the school open?
G03

For how many days from 1st May 2019 to 31 October 2019 (6 months) has the student attended school?
G04

What was the last grade scored by the child?
G05

Do you think the child is inattentive in the class?
G06

How is the child inattentive?
G07

End-time for interview