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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.
2.
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
3 Not
to b
e fil
led
bysu
rvey
ors
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:
1 .
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 ?
NO
Private health clinic in the village? YES
BASI
C S
ERVI
CES
YES
NO
NO
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?
NO
YES NO
Electricity connection in the village?
YES
YES NO
NO
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?
S O
SCHO
OLS
YES NO
YES NO
YES NO
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
1.2.
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.
2.
3.
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
know
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
NoYes
SchoolDevelopmentGrant (SDG)
Don’tknow NoYes Don’t
know
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
NoYes
SchoolDevelopmentGrant (SDG)
Don’tknow NoYes Don’t
know
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
o.
Mother's name
dqy
Full name of family head
12345678
HH No.Total number of members in theHH who eat from the samekitchen
Mother's name Ag
e
MOTHER'S BACKGROUND INFORMATIONIf attendedschool, thenwhich Std.
completed?
Has the motherever attended
school?Sl.no.
1
2
3
4
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
Yes No
Name of child(Children age 3-16
regularly living in thehousehold) A
ge Sex
LKG
/UKG
/Nur
sery
Not
goi
ng
In school children(Currently enrolled
in school)(Age 5-16)
EGS/
AIE
, oth
er
Std
.
Gov
ernm
ent
Priv
ate
Ma
da
rsa
Out of schoolchildren
(Currently notenrolled in school)
(Age 5-16)
Nev
er e
nrol
led
Drop out
Dro
p o
ut
Whi
ch S
td. w
ere
you
in w
hen
you
left
scho
ol?
Whi
ch y
ear d
idyo
u d
rop
out
(eg.
200
7)?
Pre-schoolchildren
(Age 3-6)
Ang
anw
ad
i/Ba
lwa
di
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)
Begi
nner
Lett
er
Lang
uage
in w
hich
the
child
is te
sted
in re
adin
g?
End time of survey
Does anyone in the household have a mobilephone? Yes No If yes, what is the mobile number?
Ha
s th
e fa
ther
eve
ra
tten
ded
sch
ool?
Father'sbackgroundinformation
Age
If a
tten
ded
sch
ool,
then
whi
ch S
td.
com
ple
ted
?
Doe
s th
e ch
ild t
ake
any
pa
id tu
ition
cla
sscu
rrent
ly?
Doe
s th
e ch
ild g
o to
the
surv
eyed
sch
ool?
Yes
No
Yes
No
In w
hich
lang
uage
is th
e ch
ildta
ught
in s
choo
l?(m
ediu
m o
f in
stru
ctio
n)
How
muc
h do
you
pay
for
the
child
's tu
ition
per
mon
th?
(writ
e on
ly n
umbe
r)
If Yes
Tuitions
Wor
d
Para
Sto
ry
Math( the highest
level ONLY)
Begi
nner
Num
Rec
g 1-
9
Num
Rec
g 10
-99
Subt
ract
ion
Div
isio
n
Has anyone in theHH completed 12th
Std?*
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.
2.
No
Yes
Yes No
Whi
ch sa
mpl
e no
. was
use
dto
test
the
child
(1/2
/3/4
)
*Do not include theabove mentionedmother(s) and father(s).
For age 5-16
English( the highest level ONLY)
Begi
nner
Ca
pita
l let
ter
Sma
ll let
ter
Wor
d
Sent
ence
Reading
Ca
n sa
y
Ca
nnot
say
Ca
n sa
y
Ca
nnot
say
MeaningWord Sentence
Total
State: ___________________ District: _____________________ Block: _________________ Village: ___________________Se
rial n
o.
Mother's name
dqy
Full name of family head
12345678
HH No.Total number of members in theHH who eat from the samekitchen
Mother's name Ag
e
MOTHER'S BACKGROUND INFORMATIONIf attendedschool, thenwhich Std.
completed?
Has the motherever attended
school?Sl.no.
1
2
3
4
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
Yes No
Name of child(Children age 3-16
regularly living in thehousehold) A
ge Sex
LKG
/UKG
/Nur
sery
Not
goi
ng
In school children(Currently enrolled
in school)(Age 5-16)
EGS/
AIE
, oth
er
Std
.
Gov
ernm
ent
Priv
ate
Ma
da
rsa
Out of schoolchildren
(Currently notenrolled in school)
(Age 5-16)
Nev
er e
nrol
led
Drop out
Dro
p o
ut
Whi
ch S
td. w
ere
you
in w
hen
you
left
scho
ol?
Whi
ch y
ear d
idyo
u d
rop
out
(eg.
200
7)?
Pre-schoolchildren
(Age 3-6)
Ang
anw
ad
i/Ba
lwa
di
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)
Begi
nner
Lett
er
Lang
uage
in w
hich
the
child
is te
sted
in re
adin
g?
End time of survey
Does anyone in the household have a mobilephone? Yes No If yes, what is the mobile number?
Ha
s th
e fa
ther
eve
ra
tten
ded
sch
ool?
Father'sbackgroundinformation
Age
If a
tten
ded
sch
ool,
then
whi
ch S
td.
com
ple
ted
?
Doe
s th
e ch
ild t
ake
any
pa
id tu
ition
cla
sscu
rrent
ly?
Doe
s th
e ch
ild g
o to
the
surv
eyed
sch
ool?
Yes
No
Yes
No
In w
hich
lang
uage
is th
e ch
ildta
ught
in s
choo
l?(m
ediu
m o
f in
stru
ctio
n)
How
muc
h do
you
pay
for
the
child
's tu
ition
per
mon
th?
(writ
e on
ly n
umbe
r)
If Yes
Tuitions
Wor
d
Para
Sto
ry
Math( the highest
level ONLY)
Begi
nner
Num
Rec
g 1-
9
Num
Rec
g 10
-99
Subt
ract
ion
Div
isio
n
Has anyone in theHH completed 12th
Std?*
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.
2.
No
Yes
Yes No
Whi
ch sa
mpl
e no
. was
use
dto
test
the
child
(1/2
/3/4
)
*Do not include theabove mentionedmother(s) and father(s).
For age 5-16
English( the highest level ONLY)
Begi
nner
Ca
pita
l let
ter
Sma
ll let
ter
Wor
d
Sent
ence
Reading
Ca
n sa
y
Ca
nnot
say
Ca
n sa
y
Ca
nnot
say
MeaningWord Sentence
Total
State: ___________________ District: _____________________ Block: _________________ Village: ___________________Se
rial n
o.
Mother's name
dqy
Full name of family head
12345678
HH No.Total number of members in theHH who eat from the samekitchen
Mother's name Ag
e
MOTHER'S BACKGROUND INFORMATIONIf attendedschool, thenwhich Std.
completed?
Has the motherever attended
school?Sl.no.
1
2
3
4
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
Yes No
Name of child(Children age 3-16
regularly living in thehousehold) A
ge Sex
LKG
/UKG
/Nur
sery
Not
goi
ng
In school children(Currently enrolled
in school)(Age 5-16)
EGS/
AIE
, oth
er
Std
.
Gov
ernm
ent
Priv
ate
Ma
da
rsa
Out of schoolchildren
(Currently notenrolled in school)
(Age 5-16)
Nev
er e
nrol
led
Drop out
Dro
p o
ut
Whi
ch S
td. w
ere
you
in w
hen
you
left
scho
ol?
Whi
ch y
ear d
idyo
u d
rop
out
(eg.
200
7)?
Pre-schoolchildren
(Age 3-6)
Ang
anw
ad
i/Ba
lwa
di
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)
Begi
nner
Lett
er
Lang
uage
in w
hich
the
child
is te
sted
in re
adin
g?
End time of survey
Does anyone in the household have a mobilephone? Yes No If yes, what is the mobile number?
Ha
s th
e fa
ther
eve
ra
tten
ded
sch
ool?
Father'sbackgroundinformation
Age
If a
tten
ded
sch
ool,
then
whi
ch S
td.
com
ple
ted
?
Doe
s th
e ch
ild t
ake
any
pa
id tu
ition
cla
sscu
rrent
ly?
Doe
s th
e ch
ild g
o to
the
surv
eyed
sch
ool?
Yes
No
Yes
No
In w
hich
lang
uage
is th
e ch
ildta
ught
in s
choo
l?(m
ediu
m o
f in
stru
ctio
n)
How
muc
h do
you
pay
for
the
child
's tu
ition
per
mon
th?
(writ
e on
ly n
umbe
r)
If Yes
Tuitions
Wor
d
Para
Sto
ry
Math( the highest
level ONLY)
Begi
nner
Num
Rec
g 1-
9
Num
Rec
g 10
-99
Subt
ract
ion
Div
isio
n
Has anyone in theHH completed 12th
Std?*
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.
2.
No
Yes
Yes No
Whi
ch sa
mpl
e no
. was
use
dto
test
the
child
(1/2
/3/4
)
*Do not include theabove mentionedmother(s) and father(s).
For age 5-16
English( the highest level ONLY)
Begi
nner
Ca
pita
l let
ter
Sma
ll let
ter
Wor
d
Sent
ence
Reading
Ca
n sa
y
Ca
nnot
say
Ca
n sa
y
Ca
nnot
say
MeaningWord Sentence
Total
State: ___________________ District: _____________________ Block: _________________ Village: ___________________Se
rial n
o.
Mother's name
dqy
Full name of family head
12345678
HH No.Total number of members in theHH who eat from the samekitchen
Mother's name Ag
e
MOTHER'S BACKGROUND INFORMATIONIf attendedschool, thenwhich Std.
completed?
Has the motherever attended
school?Sl.no.
1
2
3
4
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
Yes No
Name of child(Children age 3-16
regularly living in thehousehold) A
ge Sex
LKG
/UKG
/Nur
sery
Not
goi
ng
In school children(Currently enrolled
in school)(Age 5-16)
EGS/
AIE
, oth
er
Std
.
Gov
ernm
ent
Priv
ate
Ma
da
rsa
Out of schoolchildren
(Currently notenrolled in school)
(Age 5-16)
Nev
er e
nrol
led
Drop out
Dro
p o
ut
Whi
ch S
td. w
ere
you
in w
hen
you
left
scho
ol?
Whi
ch y
ear d
idyo
u d
rop
out
(eg.
200
7)?
Pre-schoolchildren
(Age 3-6)
Ang
anw
ad
i/Ba
lwa
di
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)
Begi
nner
Lett
er
Lang
uage
in w
hich
the
child
is te
sted
in re
adin
g?
End time of survey
Does anyone in the household have a mobilephone? Yes No If yes, what is the mobile number?
Ha
s th
e fa
ther
eve
ra
tten
ded
sch
ool?
Father'sbackgroundinformation
Age
If a
tten
ded
sch
ool,
then
whi
ch S
td.
com
ple
ted
?
Doe
s th
e ch
ild t
ake
any
pa
id tu
ition
cla
sscu
rrent
ly?
Doe
s th
e ch
ild g
o to
the
surv
eyed
sch
ool?
Yes
No
Yes
No
In w
hich
lang
uage
is th
e ch
ildta
ught
in s
choo
l?(m
ediu
m o
f in
stru
ctio
n)
How
muc
h do
you
pay
for
the
child
's tu
ition
per
mon
th?
(writ
e on
ly n
umbe
r)
If Yes
Tuitions
Wor
d
Para
Sto
ry
Math( the highest
level ONLY)
Begi
nner
Num
Rec
g 1-
9
Num
Rec
g 10
-99
Subt
ract
ion
Div
isio
n
Has anyone in theHH completed 12th
Std?*
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.
2.
No
Yes
Yes No
Whi
ch sa
mpl
e no
. was
use
dto
test
the
child
(1/2
/3/4
)
*Do not include theabove mentionedmother(s) and father(s).
For age 5-16
English( the highest level ONLY)
Begi
nner
Ca
pita
l let
ter
Sma
ll let
ter
Wor
d
Sent
ence
Reading
Ca
n sa
y
Ca
nnot
say
Ca
n sa
y
Ca
nnot
say
MeaningWord Sentence
Total
State: ___________________ District: _____________________ Block: _________________ Village: ___________________Se
rial n
o.
Mother's name
dqy
Full name of family head
12345678
HH No.Total number of members in theHH who eat from the samekitchen
Mother's name Ag
e
MOTHER'S BACKGROUND INFORMATIONIf attendedschool, thenwhich Std.
completed?
Has the motherever attended
school?Sl.no.
1
2
3
4
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
Yes No
Name of child(Children age 3-16
regularly living in thehousehold) A
ge Sex
LKG
/UKG
/Nur
sery
Not
goi
ng
In school children(Currently enrolled
in school)(Age 5-16)
EGS/
AIE
, oth
er
Std
.
Gov
ernm
ent
Priv
ate
Ma
da
rsa
Out of schoolchildren
(Currently notenrolled in school)
(Age 5-16)
Nev
er e
nrol
led
Drop out
Dro
p o
ut
Whi
ch S
td. w
ere
you
in w
hen
you
left
scho
ol?
Whi
ch y
ear d
idyo
u d
rop
out
(eg.
200
7)?
Pre-schoolchildren
(Age 3-6)
Ang
anw
ad
i/Ba
lwa
di
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)
Begi
nner
Lett
er
Lang
uage
in w
hich
the
child
is te
sted
in re
adin
g?
End time of survey
Does anyone in the household have a mobilephone? Yes No If yes, what is the mobile number?
Ha
s th
e fa
ther
eve
ra
tten
ded
sch
ool?
Father'sbackgroundinformation
Age
If a
tten
ded
sch
ool,
then
whi
ch S
td.
com
ple
ted
?
Doe
s th
e ch
ild t
ake
any
pa
id tu
ition
cla
sscu
rrent
ly?
Doe
s th
e ch
ild g
o to
the
surv
eyed
sch
ool?
Yes
No
Yes
No
In w
hich
lang
uage
is th
e ch
ildta
ught
in s
choo
l?(m
ediu
m o
f in
stru
ctio
n)
How
muc
h do
you
pay
for
the
child
's tu
ition
per
mon
th?
(writ
e on
ly n
umbe
r)
If Yes
Tuitions
Wor
d
Para
Sto
ry
Math( the highest
level ONLY)
Begi
nner
Num
Rec
g 1-
9
Num
Rec
g 10
-99
Subt
ract
ion
Div
isio
n
Has anyone in theHH completed 12th
Std?*
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.
2.
No
Yes
Yes No
Whi
ch sa
mpl
e no
. was
use
dto
test
the
child
(1/2
/3/4
)
*Do not include theabove mentionedmother(s) and father(s).
For age 5-16
English( the highest level ONLY)
Begi
nner
Ca
pita
l let
ter
Sma
ll let
ter
Wor
d
Sent
ence
Reading
Ca
n sa
y
Ca
nnot
say
Ca
n sa
y
Ca
nnot
say
MeaningWord Sentence
Total
State: ___________________ District: _____________________ Block: _________________ Village: ___________________Se
rial n
o.
Mother's name
dqy
Full name of family head
12345678
HH No.Total number of members in theHH who eat from the samekitchen
Mother's name Ag
e
MOTHER'S BACKGROUND INFORMATIONIf attendedschool, thenwhich Std.
completed?
Has the motherever attended
school?Sl.no.
1
2
3
4
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
Yes No
Name of child(Children age 3-16
regularly living in thehousehold) A
ge Sex
LKG
/UKG
/Nur
sery
Not
goi
ng
In school children(Currently enrolled
in school)(Age 5-16)
EGS/
AIE
, oth
er
Std
.
Gov
ernm
ent
Priv
ate
Ma
da
rsa
Out of schoolchildren
(Currently notenrolled in school)
(Age 5-16)
Nev
er e
nrol
led
Drop out
Dro
p o
ut
Whi
ch S
td. w
ere
you
in w
hen
you
left
scho
ol?
Whi
ch y
ear d
idyo
u d
rop
out
(eg.
200
7)?
Pre-schoolchildren
(Age 3-6)
Ang
anw
ad
i/Ba
lwa
di
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)
Begi
nner
Lett
er
Lang
uage
in w
hich
the
child
is te
sted
in re
adin
g?
End time of survey
Does anyone in the household have a mobilephone? Yes No If yes, what is the mobile number?
Ha
s th
e fa
ther
eve
ra
tten
ded
sch
ool?
Father'sbackgroundinformation
Age
If a
tten
ded
sch
ool,
then
whi
ch S
td.
com
ple
ted
?
Doe
s th
e ch
ild t
ake
any
pa
id tu
ition
cla
sscu
rrent
ly?
Doe
s th
e ch
ild g
o to
the
surv
eyed
sch
ool?
Yes
No
Yes
No
In w
hich
lang
uage
is th
e ch
ildta
ught
in s
choo
l?(m
ediu
m o
f in
stru
ctio
n)
How
muc
h do
you
pay
for
the
child
's tu
ition
per
mon
th?
(writ
e on
ly n
umbe
r)
If Yes
Tuitions
Wor
d
Para
Sto
ry
Math( the highest
level ONLY)
Begi
nner
Num
Rec
g 1-
9
Num
Rec
g 10
-99
Subt
ract
ion
Div
isio
n
Has anyone in theHH completed 12th
Std?*
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.
2.
No
Yes
Yes No
Whi
ch sa
mpl
e no
. was
use
dto
test
the
child
(1/2
/3/4
)
*Do not include theabove mentionedmother(s) and father(s).
For age 5-16
English( the highest level ONLY)
Begi
nner
Ca
pita
l let
ter
Sma
ll let
ter
Wor
d
Sent
ence
Reading
Ca
n sa
y
Ca
nnot
say
Ca
n sa
y
Ca
nnot
say
MeaningWord Sentence
Total
State: ___________________ District: _____________________ Block: _________________ Village: ___________________Se
rial n
o.
Mother's name
dqy
Full name of family head
12345678
HH No.Total number of members in theHH who eat from the samekitchen
Mother's name Ag
e
MOTHER'S BACKGROUND INFORMATIONIf attendedschool, thenwhich Std.
completed?
Has the motherever attended
school?Sl.no.
1
2
3
4
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
Yes No
Name of child(Children age 3-16
regularly living in thehousehold) A
ge Sex
LKG
/UKG
/Nur
sery
Not
goi
ng
In school children(Currently enrolled
in school)(Age 5-16)
EGS/
AIE
, oth
er
Std
.
Gov
ernm
ent
Priv
ate
Ma
da
rsa
Out of schoolchildren
(Currently notenrolled in school)
(Age 5-16)
Nev
er e
nrol
led
Drop out
Dro
p o
ut
Whi
ch S
td. w
ere
you
in w
hen
you
left
scho
ol?
Whi
ch y
ear d
idyo
u d
rop
out
(eg.
200
7)?
Pre-schoolchildren
(Age 3-6)
Ang
anw
ad
i/Ba
lwa
di
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)
Begi
nner
Lett
er
Lang
uage
in w
hich
the
child
is te
sted
in re
adin
g?
End time of survey
Does anyone in the household have a mobilephone? Yes No If yes, what is the mobile number?
Ha
s th
e fa
ther
eve
ra
tten
ded
sch
ool?
Father'sbackgroundinformation
Age
If a
tten
ded
sch
ool,
then
whi
ch S
td.
com
ple
ted
?
Doe
s th
e ch
ild t
ake
any
pa
id tu
ition
cla
sscu
rrent
ly?
Doe
s th
e ch
ild g
o to
the
surv
eyed
sch
ool?
Yes
No
Yes
No
In w
hich
lang
uage
is th
e ch
ildta
ught
in s
choo
l?(m
ediu
m o
f in
stru
ctio
n)
How
muc
h do
you
pay
for
the
child
's tu
ition
per
mon
th?
(writ
e on
ly n
umbe
r)
If Yes
Tuitions
Wor
d
Para
Sto
ry
Math( the highest
level ONLY)
Begi
nner
Num
Rec
g 1-
9
Num
Rec
g 10
-99
Subt
ract
ion
Div
isio
n
Has anyone in theHH completed 12th
Std?*
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.
2.
No
Yes
Yes No
Whi
ch sa
mpl
e no
. was
use
dto
test
the
child
(1/2
/3/4
)
*Do not include theabove mentionedmother(s) and father(s).
For age 5-16
English( the highest level ONLY)
Begi
nner
Ca
pita
l let
ter
Sma
ll let
ter
Wor
d
Sent
ence
Reading
Ca
n sa
y
Ca
nnot
say
Ca
n sa
y
Ca
nnot
say
MeaningWord Sentence
Total
State: ___________________ District: _____________________ Block: _________________ Village: ___________________Se
rial n
o.
Mother's name
dqy
Full name of family head
12345678
HH No.Total number of members in theHH who eat from the samekitchen
Mother's name Ag
e
MOTHER'S BACKGROUND INFORMATIONIf attendedschool, thenwhich Std.
completed?
Has the motherever attended
school?Sl.no.
1
2
3
4
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
Yes No
Name of child(Children age 3-16
regularly living in thehousehold) A
ge Sex
LKG
/UKG
/Nur
sery
Not
goi
ng
In school children(Currently enrolled
in school)(Age 5-16)
EGS/
AIE
, oth
er
Std
.
Gov
ernm
ent
Priv
ate
Ma
da
rsa
Out of schoolchildren
(Currently notenrolled in school)
(Age 5-16)
Nev
er e
nrol
led
Drop out
Dro
p o
ut
Whi
ch S
td. w
ere
you
in w
hen
you
left
scho
ol?
Whi
ch y
ear d
idyo
u d
rop
out
(eg.
200
7)?
Pre-schoolchildren
(Age 3-6)
Ang
anw
ad
i/Ba
lwa
di
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)
Begi
nner
Lett
er
Lang
uage
in w
hich
the
child
is te
sted
in re
adin
g?
End time of survey
Does anyone in the household have a mobilephone? Yes No If yes, what is the mobile number?
Ha
s th
e fa
ther
eve
ra
tten
ded
sch
ool?
Father'sbackgroundinformation
Age
If a
tten
ded
sch
ool,
then
whi
ch S
td.
com
ple
ted
?
Doe
s th
e ch
ild t
ake
any
pa
id tu
ition
cla
sscu
rrent
ly?
Doe
s th
e ch
ild g
o to
the
surv
eyed
sch
ool?
Yes
No
Yes
No
In w
hich
lang
uage
is th
e ch
ildta
ught
in s
choo
l?(m
ediu
m o
f in
stru
ctio
n)
How
muc
h do
you
pay
for
the
child
's tu
ition
per
mon
th?
(writ
e on
ly n
umbe
r)
If Yes
Tuitions
Wor
d
Para
Sto
ry
Math( the highest
level ONLY)
Begi
nner
Num
Rec
g 1-
9
Num
Rec
g 10
-99
Subt
ract
ion
Div
isio
n
Has anyone in theHH completed 12th
Std?*
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.
2.
No
Yes
Yes No
Whi
ch sa
mpl
e no
. was
use
dto
test
the
child
(1/2
/3/4
)
*Do not include theabove mentionedmother(s) and father(s).
For age 5-16
English( the highest level ONLY)
Begi
nner
Ca
pita
l let
ter
Sma
ll let
ter
Wor
d
Sent
ence
Reading
Ca
n sa
y
Ca
nnot
say
Ca
n sa
y
Ca
nnot
say
MeaningWord Sentence
Total
State: ___________________ District: _____________________ Block: _________________ Village: ___________________Se
rial n
o.
Mother's name
dqy
Full name of family head
12345678
HH No.Total number of members in theHH who eat from the samekitchen
Mother's name Ag
e
MOTHER'S BACKGROUND INFORMATIONIf attendedschool, thenwhich Std.
completed?
Has the motherever attended
school?Sl.no.
1
2
3
4
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
Yes No
Name of child(Children age 3-16
regularly living in thehousehold) A
ge Sex
LKG
/UKG
/Nur
sery
Not
goi
ng
In school children(Currently enrolled
in school)(Age 5-16)
EGS/
AIE
, oth
er
Std
.
Gov
ernm
ent
Priv
ate
Ma
da
rsa
Out of schoolchildren
(Currently notenrolled in school)
(Age 5-16)
Nev
er e
nrol
led
Drop out
Dro
p o
ut
Whi
ch S
td. w
ere
you
in w
hen
you
left
scho
ol?
Whi
ch y
ear d
idyo
u d
rop
out
(eg.
200
7)?
Pre-schoolchildren
(Age 3-6)
Ang
anw
ad
i/Ba
lwa
di
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)
Begi
nner
Lett
er
Lang
uage
in w
hich
the
child
is te
sted
in re
adin
g?
End time of survey
Does anyone in the household have a mobilephone? Yes No If yes, what is the mobile number?
Ha
s th
e fa
ther
eve
ra
tten
ded
sch
ool?
Father'sbackgroundinformation
Age
If a
tten
ded
sch
ool,
then
whi
ch S
td.
com
ple
ted
?
Doe
s th
e ch
ild t
ake
any
pa
id tu
ition
cla
sscu
rrent
ly?
Doe
s th
e ch
ild g
o to
the
surv
eyed
sch
ool?
Yes
No
Yes
No
In w
hich
lang
uage
is th
e ch
ildta
ught
in s
choo
l?(m
ediu
m o
f in
stru
ctio
n)
How
muc
h do
you
pay
for
the
child
's tu
ition
per
mon
th?
(writ
e on
ly n
umbe
r)
If Yes
Tuitions
Wor
d
Para
Sto
ry
Math( the highest
level ONLY)
Begi
nner
Num
Rec
g 1-
9
Num
Rec
g 10
-99
Subt
ract
ion
Div
isio
n
Has anyone in theHH completed 12th
Std?*
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.
2.
No
Yes
Yes No
Whi
ch sa
mpl
e no
. was
use
dto
test
the
child
(1/2
/3/4
)
*Do not include theabove mentionedmother(s) and father(s).
For age 5-16
English( the highest level ONLY)
Begi
nner
Ca
pita
l let
ter
Sma
ll let
ter
Wor
d
Sent
ence
Reading
Ca
n sa
y
Ca
nnot
say
Ca
n sa
y
Ca
nnot
say
MeaningWord Sentence
Total
State: ___________________ District: _____________________ Block: _________________ Village: ___________________Se
rial n
o.
Mother's name
dqy
Full name of family head
12345678
HH No.Total number of members in theHH who eat from the samekitchen
Mother's name Ag
e
MOTHER'S BACKGROUND INFORMATIONIf attendedschool, thenwhich Std.
completed?
Has the motherever attended
school?Sl.no.
1
2
3
4
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
Yes No
Name of child(Children age 3-16
regularly living in thehousehold) A
ge Sex
LKG
/UKG
/Nur
sery
Not
goi
ng
In school children(Currently enrolled
in school)(Age 5-16)
EGS/
AIE
, oth
er
Std
.
Gov
ernm
ent
Priv
ate
Ma
da
rsa
Out of schoolchildren
(Currently notenrolled in school)
(Age 5-16)
Nev
er e
nrol
led
Drop out
Dro
p o
ut
Whi
ch S
td. w
ere
you
in w
hen
you
left
scho
ol?
Whi
ch y
ear d
idyo
u d
rop
out
(eg.
200
7)?
Pre-schoolchildren
(Age 3-6)
Ang
anw
ad
i/Ba
lwa
di
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)
Begi
nner
Lett
er
Lang
uage
in w
hich
the
child
is te
sted
in re
adin
g?
End time of survey
Does anyone in the household have a mobilephone? Yes No If yes, what is the mobile number?
Ha
s th
e fa
ther
eve
ra
tten
ded
sch
ool?
Father'sbackgroundinformation
Age
If a
tten
ded
sch
ool,
then
whi
ch S
td.
com
ple
ted
?
Doe
s th
e ch
ild t
ake
any
pa
id tu
ition
cla
sscu
rrent
ly?
Doe
s th
e ch
ild g
o to
the
surv
eyed
sch
ool?
Yes
No
Yes
No
In w
hich
lang
uage
is th
e ch
ildta
ught
in s
choo
l?(m
ediu
m o
f in
stru
ctio
n)
How
muc
h do
you
pay
for
the
child
's tu
ition
per
mon
th?
(writ
e on
ly n
umbe
r)
If Yes
Tuitions
Wor
d
Para
Sto
ry
Math( the highest
level ONLY)
Begi
nner
Num
Rec
g 1-
9
Num
Rec
g 10
-99
Subt
ract
ion
Div
isio
n
Has anyone in theHH completed 12th
Std?*
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.
2.
No
Yes
Yes No
Whi
ch sa
mpl
e no
. was
use
dto
test
the
child
(1/2
/3/4
)
*Do not include theabove mentionedmother(s) and father(s).
For age 5-16
English( the highest level ONLY)
Begi
nner
Ca
pita
l let
ter
Sma
ll let
ter
Wor
d
Sent
ence
Reading
Ca
n sa
y
Ca
nnot
say
Ca
n sa
y
Ca
nnot
say
MeaningWord Sentence
Total
State: ___________________ District: _____________________ Block: _________________ Village: ___________________Se
rial n
o.
Mother's name
dqy
Full name of family head
12345678
HH No.Total number of members in theHH who eat from the samekitchen
Mother's name Ag
e
MOTHER'S BACKGROUND INFORMATIONIf attendedschool, thenwhich Std.
completed?
Has the motherever attended
school?Sl.no.
1
2
3
4
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
Yes No
Name of child(Children age 3-16
regularly living in thehousehold) A
ge Sex
LKG
/UKG
/Nur
sery
Not
goi
ng
In school children(Currently enrolled
in school)(Age 5-16)
EGS/
AIE
, oth
er
Std
.
Gov
ernm
ent
Priv
ate
Ma
da
rsa
Out of schoolchildren
(Currently notenrolled in school)
(Age 5-16)
Nev
er e
nrol
led
Drop out
Dro
p o
ut
Whi
ch S
td. w
ere
you
in w
hen
you
left
scho
ol?
Whi
ch y
ear d
idyo
u d
rop
out
(eg.
200
7)?
Pre-schoolchildren
(Age 3-6)
Ang
anw
ad
i/Ba
lwa
di
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)
Begi
nner
Lett
er
Lang
uage
in w
hich
the
child
is te
sted
in re
adin
g?
End time of survey
Does anyone in the household have a mobilephone? Yes No If yes, what is the mobile number?
Ha
s th
e fa
ther
eve
ra
tten
ded
sch
ool?
Father'sbackgroundinformation
Age
If a
tten
ded
sch
ool,
then
whi
ch S
td.
com
ple
ted
?
Doe
s th
e ch
ild t
ake
any
pa
id tu
ition
cla
sscu
rrent
ly?
Doe
s th
e ch
ild g
o to
the
surv
eyed
sch
ool?
Yes
No
Yes
No
In w
hich
lang
uage
is th
e ch
ildta
ught
in s
choo
l?(m
ediu
m o
f in
stru
ctio
n)
How
muc
h do
you
pay
for
the
child
's tu
ition
per
mon
th?
(writ
e on
ly n
umbe
r)
If Yes
Tuitions
Wor
d
Para
Sto
ry
Math( the highest
level ONLY)
Begi
nner
Num
Rec
g 1-
9
Num
Rec
g 10
-99
Subt
ract
ion
Div
isio
n
Has anyone in theHH completed 12th
Std?*
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.
2.
No
Yes
Yes No
Whi
ch sa
mpl
e no
. was
use
dto
test
the
child
(1/2
/3/4
)
*Do not include theabove mentionedmother(s) and father(s).
For age 5-16
English( the highest level ONLY)
Begi
nner
Ca
pita
l let
ter
Sma
ll let
ter
Wor
d
Sent
ence
Reading
Ca
n sa
y
Ca
nnot
say
Ca
n sa
y
Ca
nnot
say
MeaningWord Sentence
Total
State: ___________________ District: _____________________ Block: _________________ Village: ___________________Se
rial n
o.
Mother's name
dqy
Full name of family head
12345678
HH No.Total number of members in theHH who eat from the samekitchen
Mother's name Ag
e
MOTHER'S BACKGROUND INFORMATIONIf attendedschool, thenwhich Std.
completed?
Has the motherever attended
school?Sl.no.
1
2
3
4
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
Yes No
Name of child(Children age 3-16
regularly living in thehousehold) A
ge Sex
LKG
/UKG
/Nur
sery
Not
goi
ng
In school children(Currently enrolled
in school)(Age 5-16)
EGS/
AIE
, oth
er
Std
.
Gov
ernm
ent
Priv
ate
Ma
da
rsa
Out of schoolchildren
(Currently notenrolled in school)
(Age 5-16)
Nev
er e
nrol
led
Drop out
Dro
p o
ut
Whi
ch S
td. w
ere
you
in w
hen
you
left
scho
ol?
Whi
ch y
ear d
idyo
u d
rop
out
(eg.
200
7)?
Pre-schoolchildren
(Age 3-6)
Ang
anw
ad
i/Ba
lwa
di
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)
Begi
nner
Lett
er
Lang
uage
in w
hich
the
child
is te
sted
in re
adin
g?
End time of survey
Does anyone in the household have a mobilephone? Yes No If yes, what is the mobile number?
Ha
s th
e fa
ther
eve
ra
tten
ded
sch
ool?
Father'sbackgroundinformation
Age
If a
tten
ded
sch
ool,
then
whi
ch S
td.
com
ple
ted
?
Doe
s th
e ch
ild t
ake
any
pa
id tu
ition
cla
sscu
rrent
ly?
Doe
s th
e ch
ild g
o to
the
surv
eyed
sch
ool?
Yes
No
Yes
No
In w
hich
lang
uage
is th
e ch
ildta
ught
in s
choo
l?(m
ediu
m o
f in
stru
ctio
n)
How
muc
h do
you
pay
for
the
child
's tu
ition
per
mon
th?
(writ
e on
ly n
umbe
r)
If Yes
Tuitions
Wor
d
Para
Sto
ry
Math( the highest
level ONLY)
Begi
nner
Num
Rec
g 1-
9
Num
Rec
g 10
-99
Subt
ract
ion
Div
isio
n
Has anyone in theHH completed 12th
Std?*
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.
2.
No
Yes
Yes No
Whi
ch sa
mpl
e no
. was
use
dto
test
the
child
(1/2
/3/4
)
*Do not include theabove mentionedmother(s) and father(s).
For age 5-16
English( the highest level ONLY)
Begi
nner
Ca
pita
l let
ter
Sma
ll let
ter
Wor
d
Sent
ence
Reading
Ca
n sa
y
Ca
nnot
say
Ca
n sa
y
Ca
nnot
say
MeaningWord Sentence
Total
State: ___________________ District: _____________________ Block: _________________ Village: ___________________Se
rial n
o.
Mother's name
dqy
Full name of family head
12345678
HH No.Total number of members in theHH who eat from the samekitchen
Mother's name Ag
e
MOTHER'S BACKGROUND INFORMATIONIf attendedschool, thenwhich Std.
completed?
Has the motherever attended
school?Sl.no.
1
2
3
4
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
Yes No
Name of child(Children age 3-16
regularly living in thehousehold) A
ge Sex
LKG
/UKG
/Nur
sery
Not
goi
ng
In school children(Currently enrolled
in school)(Age 5-16)
EGS/
AIE
, oth
er
Std
.
Gov
ernm
ent
Priv
ate
Ma
da
rsa
Out of schoolchildren
(Currently notenrolled in school)
(Age 5-16)
Nev
er e
nrol
led
Drop out
Dro
p o
ut
Whi
ch S
td. w
ere
you
in w
hen
you
left
scho
ol?
Whi
ch y
ear d
idyo
u d
rop
out
(eg.
200
7)?
Pre-schoolchildren
(Age 3-6)
Ang
anw
ad
i/Ba
lwa
di
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)
Begi
nner
Lett
er
Lang
uage
in w
hich
the
child
is te
sted
in re
adin
g?
End time of survey
Does anyone in the household have a mobilephone? Yes No If yes, what is the mobile number?
Ha
s th
e fa
ther
eve
ra
tten
ded
sch
ool?
Father'sbackgroundinformation
Age
If a
tten
ded
sch
ool,
then
whi
ch S
td.
com
ple
ted
?
Doe
s th
e ch
ild t
ake
any
pa
id tu
ition
cla
sscu
rrent
ly?
Doe
s th
e ch
ild g
o to
the
surv
eyed
sch
ool?
Yes
No
Yes
No
In w
hich
lang
uage
is th
e ch
ildta
ught
in s
choo
l?(m
ediu
m o
f in
stru
ctio
n)
How
muc
h do
you
pay
for
the
child
's tu
ition
per
mon
th?
(writ
e on
ly n
umbe
r)
If Yes
Tuitions
Wor
d
Para
Sto
ry
Math( the highest
level ONLY)
Begi
nner
Num
Rec
g 1-
9
Num
Rec
g 10
-99
Subt
ract
ion
Div
isio
n
Has anyone in theHH completed 12th
Std?*
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.
2.
No
Yes
Yes No
Whi
ch sa
mpl
e no
. was
use
dto
test
the
child
(1/2
/3/4
)
*Do not include theabove mentionedmother(s) and father(s).
For age 5-16
English( the highest level ONLY)
Begi
nner
Ca
pita
l let
ter
Sma
ll let
ter
Wor
d
Sent
ence
Reading
Ca
n sa
y
Ca
nnot
say
Ca
n sa
y
Ca
nnot
say
MeaningWord Sentence
Total
State: ___________________ District: _____________________ Block: _________________ Village: ___________________Se
rial n
o.
Mother's name
dqy
Full name of family head
12345678
HH No.Total number of members in theHH who eat from the samekitchen
Mother's name Ag
e
MOTHER'S BACKGROUND INFORMATIONIf attendedschool, thenwhich Std.
completed?
Has the motherever attended
school?Sl.no.
1
2
3
4
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
Yes No
Name of child(Children age 3-16
regularly living in thehousehold) A
ge Sex
LKG
/UKG
/Nur
sery
Not
goi
ng
In school children(Currently enrolled
in school)(Age 5-16)
EGS/
AIE
, oth
er
Std
.
Gov
ernm
ent
Priv
ate
Ma
da
rsa
Out of schoolchildren
(Currently notenrolled in school)
(Age 5-16)
Nev
er e
nrol
led
Drop out
Dro
p o
ut
Whi
ch S
td. w
ere
you
in w
hen
you
left
scho
ol?
Whi
ch y
ear d
idyo
u d
rop
out
(eg.
200
7)?
Pre-schoolchildren
(Age 3-6)
Ang
anw
ad
i/Ba
lwa
di
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)
Begi
nner
Lett
er
Lang
uage
in w
hich
the
child
is te
sted
in re
adin
g?
End time of survey
Does anyone in the household have a mobilephone? Yes No If yes, what is the mobile number?
Ha
s th
e fa
ther
eve
ra
tten
ded
sch
ool?
Father'sbackgroundinformation
Age
If a
tten
ded
sch
ool,
then
whi
ch S
td.
com
ple
ted
?
Doe
s th
e ch
ild t
ake
any
pa
id tu
ition
cla
sscu
rrent
ly?
Doe
s th
e ch
ild g
o to
the
surv
eyed
sch
ool?
Yes
No
Yes
No
In w
hich
lang
uage
is th
e ch
ildta
ught
in s
choo
l?(m
ediu
m o
f in
stru
ctio
n)
How
muc
h do
you
pay
for
the
child
's tu
ition
per
mon
th?
(writ
e on
ly n
umbe
r)
If Yes
Tuitions
Wor
d
Para
Sto
ry
Math( the highest
level ONLY)
Begi
nner
Num
Rec
g 1-
9
Num
Rec
g 10
-99
Subt
ract
ion
Div
isio
n
Has anyone in theHH completed 12th
Std?*
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.
2.
No
Yes
Yes No
Whi
ch sa
mpl
e no
. was
use
dto
test
the
child
(1/2
/3/4
)
*Do not include theabove mentionedmother(s) and father(s).
For age 5-16
English( the highest level ONLY)
Begi
nner
Ca
pita
l let
ter
Sma
ll let
ter
Wor
d
Sent
ence
Reading
Ca
n sa
y
Ca
nnot
say
Ca
n sa
y
Ca
nnot
say
MeaningWord Sentence
Total
State: ___________________ District: _____________________ Block: _________________ Village: ___________________Se
rial n
o.
Mother's name
dqy
Full name of family head
12345678
HH No.Total number of members in theHH who eat from the samekitchen
Mother's name Ag
e
MOTHER'S BACKGROUND INFORMATIONIf attendedschool, thenwhich Std.
completed?
Has the motherever attended
school?Sl.no.
1
2
3
4
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
Yes No
Name of child(Children age 3-16
regularly living in thehousehold) A
ge Sex
LKG
/UKG
/Nur
sery
Not
goi
ng
In school children(Currently enrolled
in school)(Age 5-16)
EGS/
AIE
, oth
er
Std
.
Gov
ernm
ent
Priv
ate
Ma
da
rsa
Out of schoolchildren
(Currently notenrolled in school)
(Age 5-16)
Nev
er e
nrol
led
Drop out
Dro
p o
ut
Whi
ch S
td. w
ere
you
in w
hen
you
left
scho
ol?
Whi
ch y
ear d
idyo
u d
rop
out
(eg.
200
7)?
Pre-schoolchildren
(Age 3-6)
Ang
anw
ad
i/Ba
lwa
di
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)
Begi
nner
Lett
er
Lang
uage
in w
hich
the
child
is te
sted
in re
adin
g?
End time of survey
Does anyone in the household have a mobilephone? Yes No If yes, what is the mobile number?
Ha
s th
e fa
ther
eve
ra
tten
ded
sch
ool?
Father'sbackgroundinformation
Age
If a
tten
ded
sch
ool,
then
whi
ch S
td.
com
ple
ted
?
Doe
s th
e ch
ild t
ake
any
pa
id tu
ition
cla
sscu
rrent
ly?
Doe
s th
e ch
ild g
o to
the
surv
eyed
sch
ool?
Yes
No
Yes
No
In w
hich
lang
uage
is th
e ch
ildta
ught
in s
choo
l?(m
ediu
m o
f in
stru
ctio
n)
How
muc
h do
you
pay
for
the
child
's tu
ition
per
mon
th?
(writ
e on
ly n
umbe
r)
If Yes
Tuitions
Wor
d
Para
Sto
ry
Math( the highest
level ONLY)
Begi
nner
Num
Rec
g 1-
9
Num
Rec
g 10
-99
Subt
ract
ion
Div
isio
n
Has anyone in theHH completed 12th
Std?*
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.
2.
No
Yes
Yes No
Whi
ch sa
mpl
e no
. was
use
dto
test
the
child
(1/2
/3/4
)
*Do not include theabove mentionedmother(s) and father(s).
For age 5-16
English( the highest level ONLY)
Begi
nner
Ca
pita
l let
ter
Sma
ll let
ter
Wor
d
Sent
ence
Reading
Ca
n sa
y
Ca
nnot
say
Ca
n sa
y
Ca
nnot
say
MeaningWord Sentence
Total
State: ___________________ District: _____________________ Block: _________________ Village: ___________________Se
rial n
o.
Mother's name
dqy
Full name of family head
12345678
HH No.Total number of members in theHH who eat from the samekitchen
Mother's name Ag
e
MOTHER'S BACKGROUND INFORMATIONIf attendedschool, thenwhich Std.
completed?
Has the motherever attended
school?Sl.no.
1
2
3
4
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
Yes No
Name of child(Children age 3-16
regularly living in thehousehold) A
ge Sex
LKG
/UKG
/Nur
sery
Not
goi
ng
In school children(Currently enrolled
in school)(Age 5-16)
EGS/
AIE
, oth
er
Std
.
Gov
ernm
ent
Priv
ate
Ma
da
rsa
Out of schoolchildren
(Currently notenrolled in school)
(Age 5-16)
Nev
er e
nrol
led
Drop out
Dro
p o
ut
Whi
ch S
td. w
ere
you
in w
hen
you
left
scho
ol?
Whi
ch y
ear d
idyo
u d
rop
out
(eg.
200
7)?
Pre-schoolchildren
(Age 3-6)
Ang
anw
ad
i/Ba
lwa
di
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)
Begi
nner
Lett
er
Lang
uage
in w
hich
the
child
is te
sted
in re
adin
g?
End time of survey
Does anyone in the household have a mobilephone? Yes No If yes, what is the mobile number?
Ha
s th
e fa
ther
eve
ra
tten
ded
sch
ool?
Father'sbackgroundinformation
Age
If a
tten
ded
sch
ool,
then
whi
ch S
td.
com
ple
ted
?
Doe
s th
e ch
ild t
ake
any
pa
id tu
ition
cla
sscu
rrent
ly?
Doe
s th
e ch
ild g
o to
the
surv
eyed
sch
ool?
Yes
No
Yes
No
In w
hich
lang
uage
is th
e ch
ildta
ught
in s
choo
l?(m
ediu
m o
f in
stru
ctio
n)
How
muc
h do
you
pay
for
the
child
's tu
ition
per
mon
th?
(writ
e on
ly n
umbe
r)
If Yes
Tuitions
Wor
d
Para
Sto
ry
Math( the highest
level ONLY)
Begi
nner
Num
Rec
g 1-
9
Num
Rec
g 10
-99
Subt
ract
ion
Div
isio
n
Has anyone in theHH completed 12th
Std?*
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.
2.
No
Yes
Yes No
Whi
ch sa
mpl
e no
. was
use
dto
test
the
child
(1/2
/3/4
)
*Do not include theabove mentionedmother(s) and father(s).
For age 5-16
English( the highest level ONLY)
Begi
nner
Ca
pita
l let
ter
Sma
ll let
ter
Wor
d
Sent
ence
Reading
Ca
n sa
y
Ca
nnot
say
Ca
n sa
y
Ca
nnot
say
MeaningWord Sentence
Total
State: ___________________ District: _____________________ Block: _________________ Village: ___________________Se
rial n
o.
Mother's name
dqy
Full name of family head
12345678
HH No.Total number of members in theHH who eat from the samekitchen
Mother's name Ag
e
MOTHER'S BACKGROUND INFORMATIONIf attendedschool, thenwhich Std.
completed?
Has the motherever attended
school?Sl.no.
1
2
3
4
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
Yes No
Name of child(Children age 3-16
regularly living in thehousehold) A
ge Sex
LKG
/UKG
/Nur
sery
Not
goi
ng
In school children(Currently enrolled
in school)(Age 5-16)
EGS/
AIE
, oth
er
Std
.
Gov
ernm
ent
Priv
ate
Ma
da
rsa
Out of schoolchildren
(Currently notenrolled in school)
(Age 5-16)
Nev
er e
nrol
led
Drop out
Dro
p o
ut
Whi
ch S
td. w
ere
you
in w
hen
you
left
scho
ol?
Whi
ch y
ear d
idyo
u d
rop
out
(eg.
200
7)?
Pre-schoolchildren
(Age 3-6)
Ang
anw
ad
i/Ba
lwa
di
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)
Begi
nner
Lett
er
Lang
uage
in w
hich
the
child
is te
sted
in re
adin
g?
End time of survey
Does anyone in the household have a mobilephone? Yes No If yes, what is the mobile number?
Ha
s th
e fa
ther
eve
ra
tten
ded
sch
ool?
Father'sbackgroundinformation
Age
If a
tten
ded
sch
ool,
then
whi
ch S
td.
com
ple
ted
?
Doe
s th
e ch
ild t
ake
any
pa
id tu
ition
cla
sscu
rrent
ly?
Doe
s th
e ch
ild g
o to
the
surv
eyed
sch
ool?
Yes
No
Yes
No
In w
hich
lang
uage
is th
e ch
ildta
ught
in s
choo
l?(m
ediu
m o
f in
stru
ctio
n)
How
muc
h do
you
pay
for
the
child
's tu
ition
per
mon
th?
(writ
e on
ly n
umbe
r)
If Yes
Tuitions
Wor
d
Para
Sto
ry
Math( the highest
level ONLY)
Begi
nner
Num
Rec
g 1-
9
Num
Rec
g 10
-99
Subt
ract
ion
Div
isio
n
Has anyone in theHH completed 12th
Std?*
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.
2.
No
Yes
Yes No
Whi
ch sa
mpl
e no
. was
use
dto
test
the
child
(1/2
/3/4
)
*Do not include theabove mentionedmother(s) and father(s).
For age 5-16
English( the highest level ONLY)
Begi
nner
Ca
pita
l let
ter
Sma
ll let
ter
Wor
d
Sent
ence
Reading
Ca
n sa
y
Ca
nnot
say
Ca
n sa
y
Ca
nnot
say
MeaningWord Sentence
Total
State: ___________________ District: _____________________ Block: _________________ Village: ___________________Se
rial n
o.
Mother's name
dqy
Full name of family head
12345678
HH No.Total number of members in theHH who eat from the samekitchen
Mother's name Ag
e
MOTHER'S BACKGROUND INFORMATIONIf attendedschool, thenwhich Std.
completed?
Has the motherever attended
school?Sl.no.
1
2
3
4
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
Yes No
Name of child(Children age 3-16
regularly living in thehousehold) A
ge Sex
LKG
/UKG
/Nur
sery
Not
goi
ng
In school children(Currently enrolled
in school)(Age 5-16)
EGS/
AIE
, oth
er
Std
.
Gov
ernm
ent
Priv
ate
Ma
da
rsa
Out of schoolchildren
(Currently notenrolled in school)
(Age 5-16)
Nev
er e
nrol
led
Drop out
Dro
p o
ut
Whi
ch S
td. w
ere
you
in w
hen
you
left
scho
ol?
Whi
ch y
ear d
idyo
u d
rop
out
(eg.
200
7)?
Pre-schoolchildren
(Age 3-6)
Ang
anw
ad
i/Ba
lwa
di
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)
Begi
nner
Lett
er
Lang
uage
in w
hich
the
child
is te
sted
in re
adin
g?
End time of survey
Does anyone in the household have a mobilephone? Yes No If yes, what is the mobile number?
Ha
s th
e fa
ther
eve
ra
tten
ded
sch
ool?
Father'sbackgroundinformation
Age
If a
tten
ded
sch
ool,
then
whi
ch S
td.
com
ple
ted
?
Doe
s th
e ch
ild t
ake
any
pa
id tu
ition
cla
sscu
rrent
ly?
Doe
s th
e ch
ild g
o to
the
surv
eyed
sch
ool?
Yes
No
Yes
No
In w
hich
lang
uage
is th
e ch
ildta
ught
in s
choo
l?(m
ediu
m o
f in
stru
ctio
n)
How
muc
h do
you
pay
for
the
child
's tu
ition
per
mon
th?
(writ
e on
ly n
umbe
r)
If Yes
Tuitions
Wor
d
Para
Sto
ry
Math( the highest
level ONLY)
Begi
nner
Num
Rec
g 1-
9
Num
Rec
g 10
-99
Subt
ract
ion
Div
isio
n
Has anyone in theHH completed 12th
Std?*
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.
2.
No
Yes
Yes No
Whi
ch sa
mpl
e no
. was
use
dto
test
the
child
(1/2
/3/4
)
*Do not include theabove mentionedmother(s) and father(s).
For age 5-16
English( the highest level ONLY)
Begi
nner
Ca
pita
l let
ter
Sma
ll let
ter
Wor
d
Sent
ence
Reading
Ca
n sa
y
Ca
nnot
say
Ca
n sa
y
Ca
nnot
say
MeaningWord Sentence
Total
State: ___________________ District: _____________________ Block: _________________ Village: ___________________Se
rial n
o.
Mother's name
dqy
Full name of family head
12345678
HH No.Total number of members in theHH who eat from the samekitchen
Mother's name Ag
e
MOTHER'S BACKGROUND INFORMATIONIf attendedschool, thenwhich Std.
completed?
Has the motherever attended
school?Sl.no.
1
2
3
4
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
Yes No
Name of child(Children age 3-16
regularly living in thehousehold) A
ge Sex
LKG
/UKG
/Nur
sery
Not
goi
ng
In school children(Currently enrolled
in school)(Age 5-16)
EGS/
AIE
, oth
er
Std
.
Gov
ernm
ent
Priv
ate
Ma
da
rsa
Out of schoolchildren
(Currently notenrolled in school)
(Age 5-16)
Nev
er e
nrol
led
Drop out
Dro
p o
ut
Whi
ch S
td. w
ere
you
in w
hen
you
left
scho
ol?
Whi
ch y
ear d
idyo
u d
rop
out
(eg.
200
7)?
Pre-schoolchildren
(Age 3-6)
Ang
anw
ad
i/Ba
lwa
di
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)
Begi
nner
Lett
er
Lang
uage
in w
hich
the
child
is te
sted
in re
adin
g?
End time of survey
Does anyone in the household have a mobilephone? Yes No If yes, what is the mobile number?
Ha
s th
e fa
ther
eve
ra
tten
ded
sch
ool?
Father'sbackgroundinformation
Age
If a
tten
ded
sch
ool,
then
whi
ch S
td.
com
ple
ted
?
Doe
s th
e ch
ild t
ake
any
pa
id tu
ition
cla
sscu
rrent
ly?
Doe
s th
e ch
ild g
o to
the
surv
eyed
sch
ool?
Yes
No
Yes
No
In w
hich
lang
uage
is th
e ch
ildta
ught
in s
choo
l?(m
ediu
m o
f in
stru
ctio
n)
How
muc
h do
you
pay
for
the
child
's tu
ition
per
mon
th?
(writ
e on
ly n
umbe
r)
If Yes
Tuitions
Wor
d
Para
Sto
ry
Math( the highest
level ONLY)
Begi
nner
Num
Rec
g 1-
9
Num
Rec
g 10
-99
Subt
ract
ion
Div
isio
n
Has anyone in theHH completed 12th
Std?*
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.
2.
No
Yes
Yes No
Whi
ch sa
mpl
e no
. was
use
dto
test
the
child
(1/2
/3/4
)
*Do not include theabove mentionedmother(s) and father(s).
For age 5-16
English( the highest level ONLY)
Begi
nner
Ca
pita
l let
ter
Sma
ll let
ter
Wor
d
Sent
ence
Reading
Ca
n sa
y
Ca
nnot
say
Ca
n sa
y
Ca
nnot
say
MeaningWord Sentence
Total
State: ___________________ District: _____________________ Block: _________________ Village: ___________________Se
rial n
o.
Mother's name
dqy
Full name of family head
12345678
HH No.Total number of members in theHH who eat from the samekitchen
Mother's name Ag
e
MOTHER'S BACKGROUND INFORMATIONIf attendedschool, thenwhich Std.
completed?
Has the motherever attended
school?Sl.no.
1
2
3
4
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
Yes No
Name of child(Children age 3-16
regularly living in thehousehold) A
ge Sex
LKG
/UKG
/Nur
sery
Not
goi
ng
In school children(Currently enrolled
in school)(Age 5-16)
EGS/
AIE
, oth
er
Std
.
Gov
ernm
ent
Priv
ate
Ma
da
rsa
Out of schoolchildren
(Currently notenrolled in school)
(Age 5-16)
Nev
er e
nrol
led
Drop out
Dro
p o
ut
Whi
ch S
td. w
ere
you
in w
hen
you
left
scho
ol?
Whi
ch y
ear d
idyo
u d
rop
out
(eg.
200
7)?
Pre-schoolchildren
(Age 3-6)
Ang
anw
ad
i/Ba
lwa
di
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)
Begi
nner
Lett
er
Lang
uage
in w
hich
the
child
is te
sted
in re
adin
g?
End time of survey
Does anyone in the household have a mobilephone? Yes No If yes, what is the mobile number?
Ha
s th
e fa
ther
eve
ra
tten
ded
sch
ool?
Father'sbackgroundinformation
Age
If a
tten
ded
sch
ool,
then
whi
ch S
td.
com
ple
ted
?
Doe
s th
e ch
ild t
ake
any
pa
id tu
ition
cla
sscu
rrent
ly?
Doe
s th
e ch
ild g
o to
the
surv
eyed
sch
ool?
Yes
No
Yes
No
In w
hich
lang
uage
is th
e ch
ildta
ught
in s
choo
l?(m
ediu
m o
f in
stru
ctio
n)
How
muc
h do
you
pay
for
the
child
's tu
ition
per
mon
th?
(writ
e on
ly n
umbe
r)
If Yes
Tuitions
Wor
d
Para
Sto
ry
Math( the highest
level ONLY)
Begi
nner
Num
Rec
g 1-
9
Num
Rec
g 10
-99
Subt
ract
ion
Div
isio
n
Has anyone in theHH completed 12th
Std?*
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.
2.
No
Yes
Yes No
Whi
ch sa
mpl
e no
. was
use
dto
test
the
child
(1/2
/3/4
)
*Do not include theabove mentionedmother(s) and father(s).
For age 5-16
English( the highest level ONLY)
Begi
nner
Ca
pita
l let
ter
Sma
ll let
ter
Wor
d
Sent
ence
Reading
Ca
n sa
y
Ca
nnot
say
Ca
n sa
y
Ca
nnot
say
MeaningWord Sentence
Total
State: ___________________ District: _____________________ Block: _________________ Village: ___________________Se
rial n
o.
Mother's name
dqy
Full name of family head
12345678
HH No.Total number of members in theHH who eat from the samekitchen
Mother's name Ag
e
MOTHER'S BACKGROUND INFORMATIONIf attendedschool, thenwhich Std.
completed?
Has the motherever attended
school?Sl.no.
1
2
3
4
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
Yes No
Name of child(Children age 3-16
regularly living in thehousehold) A
ge Sex
LKG
/UKG
/Nur
sery
Not
goi
ng
In school children(Currently enrolled
in school)(Age 5-16)
EGS/
AIE
, oth
er
Std
.
Gov
ernm
ent
Priv
ate
Ma
da
rsa
Out of schoolchildren
(Currently notenrolled in school)
(Age 5-16)
Nev
er e
nrol
led
Drop out
Dro
p o
ut
Whi
ch S
td. w
ere
you
in w
hen
you
left
scho
ol?
Whi
ch y
ear d
idyo
u d
rop
out
(eg.
200
7)?
Pre-schoolchildren
(Age 3-6)
Ang
anw
ad
i/Ba
lwa
di
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)
Begi
nner
Lett
er
Lang
uage
in w
hich
the
child
is te
sted
in re
adin
g?
End time of survey
Does anyone in the household have a mobilephone? Yes No If yes, what is the mobile number?
Ha
s th
e fa
ther
eve
ra
tten
ded
sch
ool?
Father'sbackgroundinformation
Age
If a
tten
ded
sch
ool,
then
whi
ch S
td.
com
ple
ted
?
Doe
s th
e ch
ild t
ake
any
pa
id tu
ition
cla
sscu
rrent
ly?
Doe
s th
e ch
ild g
o to
the
surv
eyed
sch
ool?
Yes
No
Yes
No
In w
hich
lang
uage
is th
e ch
ildta
ught
in s
choo
l?(m
ediu
m o
f in
stru
ctio
n)
How
muc
h do
you
pay
for
the
child
's tu
ition
per
mon
th?
(writ
e on
ly n
umbe
r)
If Yes
Tuitions
Wor
d
Para
Sto
ry
Math( the highest
level ONLY)
Begi
nner
Num
Rec
g 1-
9
Num
Rec
g 10
-99
Subt
ract
ion
Div
isio
n
Has anyone in theHH completed 12th
Std?*
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.
2.
No
Yes
Yes No
Whi
ch sa
mpl
e no
. was
use
dto
test
the
child
(1/2
/3/4
)
*Do not include theabove mentionedmother(s) and father(s).
For age 5-16
English( the highest level ONLY)
Begi
nner
Ca
pita
l let
ter
Sma
ll let
ter
Wor
d
Sent
ence
Reading
Ca
n sa
y
Ca
nnot
say
Ca
n sa
y
Ca
nnot
say
MeaningWord Sentence
Total
State: ___________________ District: _____________________ Block: _________________ Village: ___________________Se
rial n
o.
Mother's name
dqy
Full name of family head
12345678
HH No.Total number of members in theHH who eat from the samekitchen
Mother's name Ag
e
MOTHER'S BACKGROUND INFORMATIONIf attendedschool, thenwhich Std.
completed?
Has the motherever attended
school?Sl.no.
1
2
3
4
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
Yes No
Name of child(Children age 3-16
regularly living in thehousehold) A
ge Sex
LKG
/UKG
/Nur
sery
Not
goi
ng
In school children(Currently enrolled
in school)(Age 5-16)
EGS/
AIE
, oth
er
Std
.
Gov
ernm
ent
Priv
ate
Ma
da
rsa
Out of schoolchildren
(Currently notenrolled in school)
(Age 5-16)
Nev
er e
nrol
led
Drop out
Dro
p o
ut
Whi
ch S
td. w
ere
you
in w
hen
you
left
scho
ol?
Whi
ch y
ear d
idyo
u d
rop
out
(eg.
200
7)?
Pre-schoolchildren
(Age 3-6)
Ang
anw
ad
i/Ba
lwa
di
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)
Begi
nner
Lett
er
Lang
uage
in w
hich
the
child
is te
sted
in re
adin
g?
End time of survey
Does anyone in the household have a mobilephone? Yes No If yes, what is the mobile number?
Ha
s th
e fa
ther
eve
ra
tten
ded
sch
ool?
Father'sbackgroundinformation
Age
If a
tten
ded
sch
ool,
then
whi
ch S
td.
com
ple
ted
?
Doe
s th
e ch
ild t
ake
any
pa
id tu
ition
cla
sscu
rrent
ly?
Doe
s th
e ch
ild g
o to
the
surv
eyed
sch
ool?
Yes
No
Yes
No
In w
hich
lang
uage
is th
e ch
ildta
ught
in s
choo
l?(m
ediu
m o
f in
stru
ctio
n)
How
muc
h do
you
pay
for
the
child
's tu
ition
per
mon
th?
(writ
e on
ly n
umbe
r)
If Yes
Tuitions
Wor
d
Para
Sto
ry
Math( the highest
level ONLY)
Begi
nner
Num
Rec
g 1-
9
Num
Rec
g 10
-99
Subt
ract
ion
Div
isio
n
Has anyone in theHH completed 12th
Std?*
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.
2.
No
Yes
Yes No
Whi
ch sa
mpl
e no
. was
use
dto
test
the
child
(1/2
/3/4
)
*Do not include theabove mentionedmother(s) and father(s).
For age 5-16
English( the highest level ONLY)
Begi
nner
Ca
pita
l let
ter
Sma
ll let
ter
Wor
d
Sent
ence
Reading
Ca
n sa
y
Ca
nnot
say
Ca
n sa
y
Ca
nnot
say
MeaningWord Sentence
Total
State: ___________________ District: _____________________ Block: _________________ Village: ___________________Se
rial n
o.
Mother's name
dqy
Full name of family head
12345678
HH No.Total number of members in theHH who eat from the samekitchen
Mother's name Ag
e
MOTHER'S BACKGROUND INFORMATIONIf attendedschool, thenwhich Std.
completed?
Has the motherever attended
school?Sl.no.
1
2
3
4
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
Yes No
Name of child(Children age 3-16
regularly living in thehousehold) A
ge Sex
LKG
/UKG
/Nur
sery
Not
goi
ng
In school children(Currently enrolled
in school)(Age 5-16)
EGS/
AIE
, oth
er
Std
.
Gov
ernm
ent
Priv
ate
Ma
da
rsa
Out of schoolchildren
(Currently notenrolled in school)
(Age 5-16)
Nev
er e
nrol
led
Drop out
Dro
p o
ut
Whi
ch S
td. w
ere
you
in w
hen
you
left
scho
ol?
Whi
ch y
ear d
idyo
u d
rop
out
(eg.
200
7)?
Pre-schoolchildren
(Age 3-6)
Ang
anw
ad
i/Ba
lwa
di
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)
Begi
nner
Lett
er
Lang
uage
in w
hich
the
child
is te
sted
in re
adin
g?
End time of survey
Does anyone in the household have a mobilephone? Yes No If yes, what is the mobile number?
Ha
s th
e fa
ther
eve
ra
tten
ded
sch
ool?
Father'sbackgroundinformation
Age
If a
tten
ded
sch
ool,
then
whi
ch S
td.
com
ple
ted
?
Doe
s th
e ch
ild t
ake
any
pa
id tu
ition
cla
sscu
rrent
ly?
Doe
s th
e ch
ild g
o to
the
surv
eyed
sch
ool?
Yes
No
Yes
No
In w
hich
lang
uage
is th
e ch
ildta
ught
in s
choo
l?(m
ediu
m o
f in
stru
ctio
n)
How
muc
h do
you
pay
for
the
child
's tu
ition
per
mon
th?
(writ
e on
ly n
umbe
r)
If Yes
Tuitions
Wor
d
Para
Sto
ry
Math( the highest
level ONLY)
Begi
nner
Num
Rec
g 1-
9
Num
Rec
g 10
-99
Subt
ract
ion
Div
isio
n
Has anyone in theHH completed 12th
Std?*
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.
2.
No
Yes
Yes No
Whi
ch sa
mpl
e no
. was
use
dto
test
the
child
(1/2
/3/4
)
*Do not include theabove mentionedmother(s) and father(s).
For age 5-16
English( the highest level ONLY)
Begi
nner
Ca
pita
l let
ter
Sma
ll let
ter
Wor
d
Sent
ence
Reading
Ca
n sa
y
Ca
nnot
say
Ca
n sa
y
Ca
nnot
say
MeaningWord Sentence
Total
State: ___________________ District: _____________________ Block: _________________ Village: ___________________Se
rial n
o.
Mother's name
dqy
Full name of family head
12345678
HH No.Total number of members in theHH who eat from the samekitchen
Mother's name Ag
e
MOTHER'S BACKGROUND INFORMATIONIf attendedschool, thenwhich Std.
completed?
Has the motherever attended
school?Sl.no.
1
2
3
4
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
Yes No
Name of child(Children age 3-16
regularly living in thehousehold) A
ge Sex
LKG
/UKG
/Nur
sery
Not
goi
ng
In school children(Currently enrolled
in school)(Age 5-16)
EGS/
AIE
, oth
er
Std
.
Gov
ernm
ent
Priv
ate
Ma
da
rsa
Out of schoolchildren
(Currently notenrolled in school)
(Age 5-16)
Nev
er e
nrol
led
Drop out
Dro
p o
ut
Whi
ch S
td. w
ere
you
in w
hen
you
left
scho
ol?
Whi
ch y
ear d
idyo
u d
rop
out
(eg.
200
7)?
Pre-schoolchildren
(Age 3-6)
Ang
anw
ad
i/Ba
lwa
di
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)
Begi
nner
Lett
er
Lang
uage
in w
hich
the
child
is te
sted
in re
adin
g?
End time of survey
Does anyone in the household have a mobilephone? Yes No If yes, what is the mobile number?
Ha
s th
e fa
ther
eve
ra
tten
ded
sch
ool?
Father'sbackgroundinformation
Age
If a
tten
ded
sch
ool,
then
whi
ch S
td.
com
ple
ted
?
Doe
s th
e ch
ild t
ake
any
pa
id tu
ition
cla
sscu
rrent
ly?
Doe
s th
e ch
ild g
o to
the
surv
eyed
sch
ool?
Yes
No
Yes
No
In w
hich
lang
uage
is th
e ch
ildta
ught
in s
choo
l?(m
ediu
m o
f in
stru
ctio
n)
How
muc
h do
you
pay
for
the
child
's tu
ition
per
mon
th?
(writ
e on
ly n
umbe
r)
If Yes
Tuitions
Wor
d
Para
Sto
ry
Math( the highest
level ONLY)
Begi
nner
Num
Rec
g 1-
9
Num
Rec
g 10
-99
Subt
ract
ion
Div
isio
n
Has anyone in theHH completed 12th
Std?*
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.
2.
No
Yes
Yes No
Whi
ch sa
mpl
e no
. was
use
dto
test
the
child
(1/2
/3/4
)
*Do not include theabove mentionedmother(s) and father(s).
For age 5-16
English( the highest level ONLY)
Begi
nner
Ca
pita
l let
ter
Sma
ll let
ter
Wor
d
Sent
ence
Reading
Ca
n sa
y
Ca
nnot
say
Ca
n sa
y
Ca
nnot
say
MeaningWord Sentence
Total
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
HH N
o.
Ha
mle
t/Se
ctio
n nu
mbe
r of H
Hfro
m th
e m
ap
Age
3 &
4 y
ears
Age
5 to
16
year
s
Number ofsurveyed
children in theHH
Number of children andtheir schooling status
Anganwadi orPre-school
status
Ang
anw
ad
i/Ba
lwa
di
LKG
/UKG
/N
urse
ry
Schooling status
Go
vern
me
nt
Priv
ate
Ma
da
rsa
EGS/
AIE
,ot
her
Out ofschool
children(currently
notenrolled)
Ne
ver
enro
lled
Dro
p o
ut
Number of children tested
Reading
Begi
nner
Lett
er
Wo
rd
Para
Stor
y
Math
Begi
nner
Num
Rec
g1-
9N
um R
ecg
10-9
9
Sub
tra
ctio
n
Div
ision
If the number ofhouseholds
surveyed in the villageis less than 20, givereasons in this box.
Basic Learning Levels
TOTAL
1
Total numberof locked
households
Total number of‘No Response’
households
English
Begi
nner
Ca
pita
l let
ter
Sma
ll le
tter
Wo
rd
Sent
ence
ReadingMeaning
Word
Ca
n sa
y
Ca
nnot
sa
y
Sentence
Ca
n sa
y
Ca
nnot
sa
y
2345
6
78
910
1112
13
141516
1718
1920
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?
8
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
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