EMIS NUMBER / School Code

YEAR

DECLARATION FORM

MINISTRY OF EDUCATION, ARTS AND CULTURE

ANNUAL EDUCATION CENSUS

TO BE COMPLETED BY ALL FORMAL SCHOOLS

SCHOOL NAME

[Please enter Year and School Code at the top of each page of the census form]

The Annual Education Census is the most important source of information regarding the situation at your school.
The information collected will contribute to a sound Education Management Information System (EMIS) for the
region and the country and will be of value to the management, administration, regional and national planning,
supply of school resources and governance of schools.

Please read all headings and instructions carefully when completing the questionnaire.

Undertaking:

I, ………………………………………, *Principal/Acting Principal of ……………………………………….......

fully understand that my responsibility is to provide accurate information on the state of school as at the census
date. I hereby certify that the information provided in this questionnaire is correct and complete to the best of my
knowledge.

*Principal/Acting Principal: ……………………….... ……………………………… …………….....……

Please print surname and initials Signature Date and Stamp

Checked by INSPECTOR:

I certify that the information provided and reported on this questionnaire has been checked by me and is complete.

Inspector: ……………………………….. ……………………………… …………….…...……

Please print surname and initials Signature Date and Stamp

*Delete whichever is not applicable!

 A. General School Information School Pay point School Code
Please read the guidelines on the back of this page! (EMIS Code)

1. Name of School 1.1 Grades: From (lowest) To (highest)

3. Constituency Code
2. Region
4. School Location: Name of Town / Village/ Settlement
where school is located
Code Circuit
5. Inspection Circuit
Name
As your school belongs to a cluster, Cluster Cluster Center Name
state the code and name of the cluster Code
6. Cluster Center center school. If your school is a
cluster center, state its code and name
again
7. School Postal
Address

Tel: Fax:
8. Tel. / Fax
Number School E-
Mail:
9. School Principal Name: Principal’s
E-Mail:
Acting Home tel. no. Cell phone:

Tick as
10. Your school is a
(State or Private appropriate √ State school 1
school)
Private school 2

11. Your school is a

(type of school) √
Mark the category below, which best describes your school. Mark 1
box only.

1.Pre-Primary 5.Technical / Pre-vocational school

2.Primary School (Gr PP – 7)

c 6. Agricultural School
o
3.*Combined School (Gr PP – 12) u 7. Special /Resource School

4. Secondary School (Gr 8 – 12) p Other type of school (Specify) ______________________________

l
Check what kind of support your school gets from the state (GRN). If the printed information is incorrect, give the correct
12. For private
schools only information (YES or NO) in the unshaded boxe here
Teachers are appointed by the state (government)
o from the state (government)
The school receives equipment and / or textbooks
The state (government) provides some form of f financial subsidy to the school
The school receives NO support from the state w(government) in any form
13. Platoon or double Check whether the platoon or double sessione system is used at your school. If the printed information is incorrect, give the correct
–session system answer (YES or NO) in the unshaded box.
13.1 Platoon system (different teachers e NO 13.2 Double session system (the same NO
using the same classroom to teach two k teacher teaches two sessions, one after the
sessions) other)
14. Satellite schools 14.1 Does the school have satellite schools? s 14.2 Is this school a satellite of another school?
(See definition on back . of all
If it does, please list the code numbers and names
Yes No
of this form) satellite schools Yes No
Please list Names and Codes for Satellite school below
W below
Please list Names and Codes for Satellite school
Code:__________ Name:_________________________ Code:__________ Name:_________________________
e
Code:__________ Name:_________________________
15. Urban or Rural 15.1 Is this school an urban or rural school?
(See definition) a √
15.1 Mark one Urban Rural
i
16. Hostel Code Name Code Name
Accommodation m

t
o
[Please note: * for the sake of this census, schools with primary and secondary grades are to be classified Combined.]
g
o
 B.1 Summary Numbers of Teachers and Learners and Support Staff School Code
1. Total numbers of learners, teachers and support staff
Staff numbers include everyone other than hostel staff. The totals thus will include those appointed by government or non-government bodies, those who are
relief and those who are on leave as long as they are officially employed at the school.

LEARNERS TEACHERS (including the Principal and SUPPORT STAFF (Secretary/ admin. officers, clerks,
other teaching staff) cleaners, etc.)
Do NOT include hostel staff
Male Female Total Male Female Total Male Female Total

2. Learners and class groups per grade

Record the number of learners in each grade. In secondary grades, register classes are counted as class groups. In the case of multi-grade teaching (where learners
from more than one grades are taught in a group), each grade must be counted as one (1) in the column headed “Number of class-groups” and the combination of
class-group should be indicated in the second last column.

Number of learners Multi-grade

Number of Show which FOR OFFICE
Grade or Course class-groups USE ONLY
Male Female TOTAL grades are
combined
Pre-Primary (100)
Grade 1 (201)
Grade 2 (202)
Grade 3 (203)
Grade 4 (204)
Grade 5 (205)
Grade 6 (206)
Grade 7 (207)
Grade 8 (208)
Grade 9 (209)
Grade 10 (210)
Grade 11 (211)
Grade 12 (212)
Grade 13/ A level (213)
Learning Support Gr.1 (401)
Learning support Gr.2 (402)
Learning support Gr.3 (403)
Learning support Gr.4 (404)
Learning support Gr.5 (405)
Learning support Gr.6 (406)
Learning support Gr.7 (407)
Basic Pre-Voc. Skill Yr.1 (321)
Basic Pre-Voc. Skill Yr.2 (322)
Advanced Vocational (NTA
Level) (323)
Orientation phase (501)
Beginners phase (502)
Junior phase (503)
Senior phase (504)
Access (Basic Skills Phase) (505)
Autism (506)
Total
3. Number of days and periods in each time table cycle
Grade Number of days in each Number of Periods in each Length of each period in
timetable cycle timetable cycle minutes
Pre-Primary
Grade 1 - 2
Grade 3
Grade 4
Grade 5 - 7
Grade 8 - 9
Grade 10 -11
Grade 12 (AS)
Others
 B.2 Summary Numbers of Teachers and Learners School Code

1. Mortality statistics for teachers (after the last census date up to the current census date).

1. Illness 2. Accident 3. Suicide 4. Violence &

Cause of death:
Homicide
Age in years Male Female Male Female Male Female Male Female
24 and younger
25 – 29
30 – 34
35 – 39
40 – 44
45 – 49
50 – 54
55 and older
TOTAL

2. Teachers who left the school (after the last census date up to the current census date).

Reason (s) Male Female Total

Retired
Transferred to another School
Transferred to a non-teaching position
Health related ( boarded due illnesses, disability, etc.)
Dismissed
Resignation
Others (exclude death)
TOTAL

3. Did your school organize orientation session(s) regarding life skills-based HIV and Sexuality Education Programs for
parents/guardians of learners at your school this year?

(Please tick only one box)

Yes No

4. How many teachers in your school received training and are teaching Life skills-based HIV and Sexuality Education?
Write in two (2) digits e.g. if only 1 teacher in your school, indicate like 0 1

5. (a) Is your School implementing an HIV and AIDS policy for Education Sector workplace program that includes information and
training for staff on HIV and AIDS and access to prevention, care and support services?

(Please tick only one box)

Yes No

(b) Are any grievances and disciplinary procedures related to HIV and AIDS Policy for Education Sector in place?

(Please tick only one box)

No

Yes but these procedures are not enforced.

Yes, and these procedures are enforced.

C1. Class-group information School Code

1. Name of school: ___________________________________

2. Grade and class-group, e.g. Grade 1 A: ______________________

Morning (first session only) (1)

3. Session (Mark one) √ onl
Afternoon (2)

4. Medium of Instruction (language in which subjects

Code
such as Mathematics and History are taught). (a) Main Medium:___________________
State the language and get the Code from the list of codes
on the back of Form D (NB: Medium of instruction codes) (b) Second medium, if any: ______________
Code

5. Multi-grade teaching
(a) Are learners in other grades taught together with this group Yes (1)
(for example, Grade 1 and Grade 2 combined in one group)? No (2)

(b) If the class group is multi-grade (combined group), from which grades
and classes are the other learners in the group? Grade &Class Office use

6. Number of ALL learners in the Class-group

Male Female Total

7. Number of Non-Namibian learners

Male Female Total

8. Grade Composition
Record the numbers of learners in the class-group, showing how many are first time, repeaters and how many returned to school
after leaving school before the end of last year.

(A) Learners in the grade for the first (B) Learners repeating the grade (C) Learners who returned to school
time (entering for the first time or because they failed at the end of this year after having left during
having passed previous grade at last year. or before the previous year.
the end of last year).
Male Female TOTAL Male Female TOTAL Male Female TOTAL

Learners Condoned: Of the learners in the grade for the first time (A), how many were transferred because of over age,
repetition, etc.?
Male Female TOTAL

FOR GRADE 1 ONLY

9. How many of your Grade 1 learners have had kindergarten / pre-primary Male Female Total
school experience?

10. Class teacher particulars:

Name: ______________________________ Signature: _________________________ Date: _________________

Cellphone Number: ……………………………… ID No……………………………………………

(PLEASE REMEMBER TO COMPLETE THE BACK OF PAGE) PLEASE TURN OVER

 C2. Class-group information
School Code
Grade and class-group, e.g. Grade 1 A: ______________________

11. Ages of learners 12. Home languages of learners

Record the numbers of learners in each age group as on Record the numbers of learners having one of the following
the Census Date. as their home or main language
Age Male Female TOTAL Language Group Male Female TOTAL
Silozi (11)
New Repeater New Repeater

Languages
Zambezi
5 or younger Other Zambezi (19)

6
7 Afrikaans (21)
8 English (22)

European
based
9 German (23)
10 Other European (29)
11 Rugciriku (31)
12 Rukwangali (32)

Languages
Kavango
13 Rushambyu (33)
14 Thimbukushu (34)
15 Rumanyo (35)
16 Khoekhoegowab (Damara/Nama) (41)
17 Oshindonga (51)
Oshiwa
mbo
18 Oshikwanyama (52)
19 Other Oshiwambo (59)
20 Otjiherero (61)
21 Ju/’hoasi (San Languages) (71)
22 Setswana (81)
23 Namibian Sign Language (91)
24 Other languages (99)
25 or over TOTAL
TOTAL 13. Learners participating in School Feeding Program (indicate number)
Male Female Total
14. Promotional and Compulsory subjects (See definition) and textbooks Are these books also used by
Write down all promotional and compulsory subjects taken by learners in the first column, and get the codes from the back of form D.
other classes? Mark either YES
Junior Primary teachers must indicate class teaching. For Grade 11, indicate subjects level as O and Grade 12, as AS in the third column.
or NO

Subject(s): NSSC Number of learners taking the subject Total number of textbooks
for the subject issued to class YES NO
group
Subject Name Code Level Male Female Total
O/AS

Note: Minimum Promotional subjects acceptable: Gr. 4(5), Gr. 5 – 7 (6), Gr. 8 -9 (9), Gr. 10 - 11 (6) and Gr. 12 (3-5). Please be aware
that some learners split subjects and must be counted as well.
 C3. Class-group information School Code
Grade and class-group, e.g. Grade 1 A: ______________________

15. Furniture (in the classroom): Please provide numbers’ do not tick.
Furniture Good Usable Need Total in Class
replacement
Writing Chalkboard
boards Whiteboard
Smart boards
Learners Chairs for learners
Single desks for learners
Double desks for learners
Adjustable chairs for learners with disability
Adjustable tables for learners with disability
Benches for learners
Teachers chair(s)
Teachers Teachers’ table (s)
Adjustable chair for teachers with disability
Adjustable Table for teachers with disability
*Please see definitions at the back of FORM E and User Manual.

16. Orphans and Vulnerable Children (OVC)

5 or younger

Total
Sex/ages

25 or over
learners
of

6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24

Male
Orphans

Female
Total
Male
Vulnerable

Female

Total

17. Number of learners who dropped out this year 18. Number of learner pregnancies recorded this year

Reason for dropping out Male Female TOTAL Pregnant learners Pregnant learners
Ages of
still attending who have dropped TOTAL
Illness or caring for sick relatives learners
school out of school
Distance between school and home
9 or younger
Left to get a job
10
Parents demand that learner stays
home 11
Failure to pay school development
fund / hostel fees 12
Learners feel too old for grade 13
Pregnancy related
14
Learners failed the grade
Learners had no money for 15
examination fees
16
Learners had disciplinary problems
17
Parent/s died, learner had no
caretakers 18
Hunger 19
Learner was being discriminated,
bullied by others 20
Infrastructure
21
Disability

accessibility
Learning material 22
accessibility
Language/communica 23
tion barrier
Early marriage 24
Attitude of teacher/s 25 or over
Unknown/ Others
TOTAL
Total

(PLEASE REMEMBER TO COMPLETE THE BACK OF PAGE) PLEASE TURN OVER

 C4. Class-group information School Code

Grade and class-group, e.g. Grade 1 A: ______________________

19. Life Skills and HIV&AIDS Participation

Do learners participate in HIV & Aids prevention programs, e.g. (My Future is My Choice, Window of
Hope)? (Tick appropriate box) YES NO

Male Female Total

If Yes, indicate the number of learners participating in these activities.

20. Do learners in this class group receive comprehensive life skills-based HIV and sexuality education? (See definition of HIV and
Sexuality Education at the back of Form A)
Male Female Total
Tick one Yes No If Yes; give the number of learners receiving.

If yes, indicate which of these topics were covered by ticking “Yes” or “No”

Teaching on generic life skills (generic refers to general life –skills, it starts from Pre-grade)
YES NO

Teaching on sexual reproductive health YES NO

Teaching on HIV Transmission and prevention YES NO

21. Learners experiencing learning and social difficulties (Note: If a learner has multiple disabilities they must be counted in all applicable/
relevant disability category/is). Please see back of FORM D for guidance
Remembering &
Communication

Autism Spectrum

Down Syndrome
Disorder (ASD)
Disability Category & degree

Controlling

changes to
Behaviors

Accepting

Disability
Learning

Albinism
attention

Self-care

Epilepsy
Physical
focusing
Hearing

routine
Vision
A lot of difficulty

A lot of difficulty

A lot of difficulty

A lot of difficulty

A lot of difficulty

A lot of difficulty

A lot of difficulty

A lot of difficulty

A lot of difficulty
Cannot do at all
Cannot do at all

Cannot do at all

Cannot do at all

Cannot do at all

Cannot do at all

Cannot do at all

Cannot do at all

Cannot do at all
Some difficulty

Some difficulty

Some difficulty

Some difficulty

Some difficulty

Some difficulty

Some difficulty

Some difficulty
Some difficulty
Male

Female

Total

22. Learners’ mortality statistics for this year

Cause of death

Illness Accident (car, acts of nature, etc.) Suicide Violence and Homicide
Age
Male Female Male Female Male Female Male Female

TOTAL

Name: ______________________________ Signature: _________________________ Date: _________________

 Please check the information on this form. If you find the information to be
D. Teacher Particulars wrong, missing or has changed, write the correct information into the un –
. shaded blocks. Guidelines and codes are printed on the back of the form
Teacher’s Pay Point

1. Name of School Code

Code
2. Name of Teacher Title (Mr./Ms.) Initials Surname

Ref code:

3. Present service of the Teacher Is now working at the Is on long sick Is on study leave for
(Mark one block only) school or maternity leave more than 3 months

4. Identity number and document (a) Number (b) Type of Document (see back of page)
Code

5. Sex 6. Nationality Code

(Male / female)

7. Date of Birth 8. Marital Status Code 9. Employed by

(See list of codes) (see list of codes)
(DD-MM-YYYY) Code Code
10. Salary Band & Grade 11. Employee Code 12. Appointment
Code (govt. staff only) (see list of codes)
(See list of codes) Code Code

13. Number of years of teaching experience …………... years 14. Main (Home) language Code
15. Number of years of non-teaching experience…........ years (see list of codes at the top of the
back of this form) Code

16. Rank and post occupied (a) Actual rank Code (b) Acting Capacity (if any)
Actual rank and acting capacity: see codes Code
Code Code
17. Highest academic or Code
vocational qualification Code
(see list codes)
18. Highest professional or Code
teaching qualification
(see list codes) Code
19. Indicate the subjects that you are Major: Minor:
qualified to teach

20. Qualification in phase/s

*Highest phase qualified to teach N/A PP JP SP JS SS

*Other phase/s qualified to teach N/A PP JP SP JS

21. Life Skills-based HIV and 22. HIV&AIDS training received? 23. Counseling Training? 24. Computer Skills
Sexuality Education training YES NO (0 – none, 3 – advanced)
received?
25. In-service training in Inclusive YES NO
YES NO Education received?
YES NO 0 1 2 3

26. Do you have any form of DISABILITY? YES NO

27. Subjects taught: Enter all subjects taught this year in the first column and get the codes from the list of codes on the back of this form. Junior primary
class teaching MUST be indicated as such. Also indicate the total number of lessons taught per subject per grade. Under ‘Qualification in Subject’ tick
the most appropriate (only 1 block) block to indicate your qualifications in each specific subject.
Subject Taught Grades Taught and Number of lessons per Qualifications in Subjects
subject per grade
Subject Name Code G R GR GR GR GR GR below Gd. 12 1 or 2 years 3 years
Gd. 12 after Gd. 12 plus after
Gd. 12
(1) (2) (3) (4)
(1) (2) (3) (4)
(1) (2) (3) (4)
(1) (2) (3) (4)
(1) (2) (3) (4)
(1) (2) (3) (4)
(1) (2) (3) (4)

Verified by Principal
NB: For the sake of clarity and data cleaning, please provide your contact number: __________________________________________
 Original: to be returned to Head Office 2nd Copy: To Circuit/Region 3rd Copy remains at School
 D. Codes
CODES FOR MEDIUM OF INSTRUCTION & HOME(MAIN) LANGUAGE
Code Medium
11 Silozi 23 German 33 Rushambyu 51 Oshindonga 71 San (Ju/'hoasi)
19 Other Caprivi 29 Other European 34 Thimbukushu 52 Oshikwanyama 81 Setswana
21 Afrikaans 31 Rugciriku 35 Rumanyo 59 Other Oshiwambo 91 Sign Language
22 English 32 Rukwangali 41 Khoekhoegowab 61 Otjiherero 99 Other Languages

CODES FOR CLASS TEACHING

1000 Pre-Primary class teaching 1104 Grade 4 class teaching 1107 Grade 7 class teaching
1101 Grade 1 class teaching 1105 Grade 5 class teaching 1401 Learning Support class teaching
1102 Grade 2 class teaching 1106 Grade 6 class teaching 7163 Class teaching for learners with intelectual impairment
1103 Grade 3 class teaching (Orientation, beginner phases etc.)

CODES FOR SUBJECT TEACHING

2009 Accounting Grade 8 – 12 4009 Fitting and Turning, Gd. 8-12 5598 Oshindonga, Gd.1-12
2114 Afrikaans 1st or home Language, 1-12 4159 French, Gd. 1-12 4357 Otjiherero, Gd. 1-12
2120 Afrikaans 2nd Language, 1-12 4231 General Science, Gd. 4-7 5889 Panel Beating and Spray Painting, Gd.8-12
2133 Agriculture, Grade 8 - 12 4234 Geography, Gd.8-12 5955 Performing Art, Gd.8-10
6891 Arts, Grade 1-7 4258 German 1st of Home Language, Gd. 1-12 6094 Physical Education, Gd.8-12
2409 Arts and Design, Gd. 10-12 4261 German Third / Foreign Language 8-12 6095 Physical Ed. and Health Awareness, PP-7
2410 Arts in Culture, Gd. 8-10 4285 Hairdressing, Gd. 8-12 6130 Physical Science Gd.8-9
2427 Art of Entertainment, Gd. 8-12 4297 Handwriting, Gd. 1-4 6136 Physics Gd. 10-12
2532 Basic Techniques 4298 Health and Social Care 6253 Plumbing and Sheet-Metal Work, Gd.8-12
2567 Biology, Gd. 10-12 4375 History, Gd. 8-12 2914 Reading Period, Gd. 4-9
2639 Bricklaying and Plastering, Gd.8-12 4436 Home Ecology, Gd.5-7 6800 Religious Education, Gd.1-7
2615 Building Studies 8-12 4438 Home Economics, Gd.8-12 2544 Religious and Moral Education, Gd.8-12
2729 Business Economics, Gd. 10-12 4439 Hospitality 6803 Remedial Teaching, Gd.1-12
2764 Business Studies, Gd.10-12 2524 Information and Communication Gd. 4-12 4213 Rumanyo, Gd. 1-12
2822 Catering, Gd. 8-12 4697 Integrated Performing Art, Gd.8-12 4792 Rukwangali, Gd.1-12
3024 Combined Science / Co-ordinated Science, Gd. 10-12 4785 Ju/'hoasi, Gd.1-4 6874 Salon Science, Gd. 8-12
2909 Chemistry Gd. 10-12 4784 Keyboard and Word processing, Gd.8-10 7609 Setswana, Gd. 1-12
3050 Communication & Deportment, Gd. 8-12 5575 Khoekhoegowab, Gd.1-12 6994 Sign Language
3146 Computer Literacy, Gd. 4-12 4913 Life Science, Gd. 8-10 4960 Silozi, Gd.1-12
3153 Computer Practice, Gd. 8-12 4914 Life Skills, Gd. 4-12 1401 Special Education
3173 Computer Studies, Gd. 10-12 3373 Literature (English), Gd. 10-12 7163 Specialized Education / Handicapped
3292 Craft and Technology, Gd. 3-7 4259 Literature (German), Gd. 10-12 7096 Social Studies, Gd. 4-7
3375 Design and Technology, Gd. 10-12 5134 Mathematics, Gd. 1-12 7390 Technical Drawing / Design and Communication Gd.8-12
3378 Development Studies, Gd. 10-12 5345 Metalwork and Welding, Gd.8-12 7411 Technical Studies A, Gd. 8-12
3503 Economics, Gd. 10-12 5449 Motor Body Repairing, Gd.8-12 7413 Technical Studies B, Gd. 8-12
3524 Educare, Gd. 10-12 5503 Motor Mechanics, Gd. 8-12 7415 Technical Studies C, Gd. 8-12
3582 Electricity, Gd. 8-12 6892 Music/School Music (Non-Prom), Gd1-12 7396 Technical Theory and Practice, Gd.8-12
3626 Electronics, Gd. 8-12 5554 Music (Promotion Subject), Gd. 8-12 7426 Television and Radiotricianwork, Gd. 10-12
3666 Elementary Agriculture, Gd. 5-7 5584 Natural Economy 5170 Thimbukushu, Gd.1-12
3743 Engineering Science, Gd. 10-12 5585 Natural Science and Health Educ., Gd. 4-7 7610 Typing/Typing and Office Admin. Gd.8-12
3770 English 1st language, Gd.1-12 5605 Needlework and Clothing, Gd.8-12 7751 Visual Arts, Gd. 8-12
3776 English 2nd Language Gd. 1-12 5602 Needlework (Basic Techniques), Gd. 7 7901 Woodwork, Gd.8-12
2746 Entrepreneurship, Gd. 8-12 5713 Office Practice, Gd.8-12 9999 Teacher on study leave for more than 3 months
3806 Environmental Studies, Gd. 1-3 5701 Office Administration and Keyboard application Gd. 8-12 1111 Teacher has no teaching load
3859 Fashion and Fabrics, Gd. 11-12 4795 Oshikwanyama, Gd.1-12 In all other cases, state the subject and leave the code blank.

CODES FOR TEACHERS’ PARTICULARS- FORM D

4. IDENTIFICATION – 16. RANK & POST OCCUPIED 5 Studies requiring Gr.12 to enter
TYPE OF DOCUMENT Code Post 3 or 4 years after Gr.12
Code Document Type 107 Principal: PS - SS 6 Studies requiring Gr.12 to enter
1. Namibian Identification 26 Teacher E (Grade 9) 111 Deputy Principal 5 or more years after Gr.12
Number 27 Teacher F (Grade 8) 112 Head of Department
2. Namibian passport number 28 HOD (Grade 6) 113 Teacher
3. Foreign passport number 29 Principal (Grade 5)
4. Other identification/ 30 Not Known
document number

8. MARITAL STATUS 9. EMPLOYED BY In all other cases indicate post and leave blank. 18. HIGHEST PROFESSIONAL QUALIFICATION
Code Status Code Organisation Code Category/Description
1. Single 1. Government 1 No teacher training
2. Married 2. Non-Government
2 Qualification requiring Gr.10 or lower to
enter (e.g. ECP)
3 Qualification requiring Gr.12 to enter – 1 or
2 years after Gr.12
4 Qualification requiring Gr.12 to enter – 3
or 4 years after Gr.12
5 Post-graduate teacher diploma
6 Post-graduate degree

10. SALARY BAND AND GRADE 12. APPOINTMENT 17. HIGHEST ACADEMICQUALIFICATION 24. COMPUTER SKILLS
Code Band and Grade Code Post Code Category/Description Code Level
20 Teacher A (Grade 13) 1 Permanent 1 Grade 9 or lower 0 No skills
21 Teacher B (Grade 12) 2 On probation 2 Grade 10 or 11 1 Beginners – basic skills
23 Teacher C (Grade 11) 3 Part-time (Private Schools) 3 Grade 12 2 Intermediate
24 Teacher D (Grade 10) 4 Relief 4 Studies requiring Gr.12 to enter 3 Advanced
5 Contract 1 or 2 years after Gr.12
6 Volunteer
E. PHYSICAL FACILITIES School Code

1. NAME OF SCHOOL
Check the information for your school printed in the shaded
blocks. Correction, due to errors or changes in the facilities
at your school must be recorded in the adjoining unshaded
blocks.
PLEASE BE EXTRA CAREFUL WHEN FILLING THIS FORM. BE ACCURATE.
2. NUMBERS OF DIFFERENT FACILITIES
 Check or state the number of rooms for each of the facilities according to the type of building. Note: the main material of walls distinguishes Buildings.
Buildings not belonging to the school are reported separately in the second-last column. Please read through the list before classifying the facilities at
the school.
 DO NOT COUNT ANY ROOM OR FACILITY MORE THAN ONCE.

Type of room or facility Number of rooms of each kind of building structure

Code Type Permanent Prefabricated Traditional Rooms/Faciliti TOTAL Facility accessible
(Bricks, stone panels/classes (Mud, poles, sticks, es not by wheelchair
concret, etc.) grass, corrugated iron, belonging to Tick (if Number
metal sheets, etc.) the school but yes) Accessible
used daily
01 Class rooms
02 Laboratory (Science)
03 Computer Laboratory
04 Cookery/Kitchen
05 Workshop (prevocational)
06 Rooms suitable for very
small groups only
07 Gymnasium / School Hall
08 Library/Media/
Center/Language
09 Store room(s)
10 Book Store
11 Administration Block
(Staffroom and Principal’s)
12 Other administrative /
general use facilities
13 Strong room
14 Garden or Agricultural
Project
TOTAL

3. OUTDOOR TEACHING SPACES (DO NOT COUNT SPORTS FACILITIES)

How many outdoor spaces are regularly used for teaching due to the lack (shortage) of class rooms?

4. SANITARY FACILITIES Number of individual toilet units

Check and record the number of Flush toilets Urinals spaces Other latrines e.g. pit latrines
INDIVIDUAL lavatory units (seats, Accessible by Accessible by Accessible by
urinal spaces, etc.). wheelchair wheelchair wheelchair
Not
Used Not Used Used Not used Used Not Used Used Not used Used Used Used Not used
Male learners

Female learners

Staff

TOTAL

5. BASIC SERVICES TYPE OF SERVICES At School (tick the relevant box) Nearby community or town
Check and correct (if necessary) (indicate Yes or No)
what kind of basic services are at the Pipe Borehole Well None
Water
school and/or surrounding community, C C
Electricity Main Generator Solar None
suburb or town C C
Telephone (including Yes No
cellphone, satellite or radio C C
telephone)
Wireless Cable , None
Internet connectivity
C C C
6. HOUSING FOR TEACHERS Separate house or part of a Accommodation in
Check and correct (if necessary) the TYPE OF HOUSING TOTAL
building used only for teachers hostels
number of housing units or flats for
Family Units
teachers. DO NOT count general
government housing unless it is
allocated specifically to your school by Single quarters
government.

 Original: to be returned to Head Office 2nd Copy: To Circuit/Region 3rd Copy: remains at School
F. ETSIP INDICATORS
School Code
F1. School and Community

Area Your Responses

1. School Board Does the school have an operational School Board (SB)? Y N

If Yes, how often does your SB meet each year?

For which of the following does your SB have an oversight function?
(Tick all those that apply) Tick √
Approve School Development Plan Yes No
Set school Policy, Rules and Regulations Yes No
Decide on staff/teacher issues
Yes No
(appointment, promotion, termination, etc.)
Set and manage the School Development Fund Yes No
Improve/develop school infrastructure Yes No
Disciplinary issues (teachers and other staff) Yes No
Disciplinary issues (learners) Yes No
Improve school welfare
Yes No
(health, HIV&AIDS and feeding)
Communicate with parents and community Yes No
Other – please specify up to 3 main functions:
(1)
(2)
(3)
2. School Development Does the school have School Development Fund (SDF)? Y N
Fund (Do not record
the UPE Funds) If Yes, what is the contribution per child per year? N$
What is the fund used for? (Tick all those that apply)
Tick √
To provide teaching/library materials Yes No
ONLY To provide textbooks Yes No
APPLICABLE TO
PRIVATE To pay for minor building projects Yes No
SCHOOLS
To maintain/refurbish school buildings Yes No
To pay for services (water, electricity, etc.) Yes No
To pay for extra teachers (their salaries) Yes No
To give bonuses (top-ups) to selected teachers Yes No
To employ support staff (their wages) Yes No
To run and maintain a school vehicle Yes No
To assists with teachers’ rent payments Yes No
Other – please specify up to 3 main uses:
(1)
(2)
(3)
 School Code
F3. Information and Communication Technology (ICT)
1. Computer Hardware and Operating Systems
Indicate no. of computers How were these computers
Computers NOT working in
Working computers in the school not working for these obtained (Working and not Number
the school
periods working)?
Operating system Number Number 1 – 3 months Donated by NGO (e.g.
School net, Peace Corps)
a) Windows 4 – 6 months
b) Linux 7 – 9 months Donated by private
company
c) Other Specify: 10 – more Bought by school (own
months funds)
---------------------- --------------------- Provided by Government
(Ministry)
TOTAL TOTAL TOTAL

2. Please Tick reasons why these computers have not been operational for these periods.

Broken No Electricity No know-how Others (specify below)

3. What kind of support has the school received from those who donated the computers?

Training Technical support Other (please specify below)

4. Other ICTs Equipment (indicate numbers)

Equipment Teaching and Learning and Administration

Operational Not operational Total
Printers
Photocopiers
Typewriters
Television Sets
Radio / Tape recorders
Sewing machines
Cookers/Stoves
Science Kits
Musical Instruments
DVD
Smart boards
LCD /OH Projectors
White boards
Projectors/beamers
Fax machine
Duplicating machines
Classic Manual Braille machine
Modern Braille machine
Embosser
Book reader pen
Camera ( Deaf Education)
Audio Recorder
Talking calculators
Text-To-Speech equipment
Enlarged print Screen reader
Others (specify below)
 School Code
G. Non-teaching Staff Particulars (Do not include hostel staff)

Surname Nationality Paid by ID Number/ DOB Employee code

Initials

Sex

Appointment
No. M F

Non-state
Post code

State

Post Code:
201 Admin. Officer/ School Secretary (Full time) 203 Admin. Officer/ School Secretary (10 212 Caretaker 299 Other non-teaching post (specify)
hours per week)
202 Admin. Officer/ School Secretary (25 hours per 211 Leader Cleaner 213 Cleaner
week)
 Hostel code

Hostel Pay point (s)

1. 2. 3.

H1. Hostel Information

1. Name of Hostel
2. Superintendent’s name
3. Telephone and fax numbers (if different from School) Tel: Fax:
4. Is the hostel a state or private hostel?
(private hostels are controlled by a non-government Mark one: State hostel Private hostel
organization such as a church, farm, mine or other
organization.)
6. Classification of hostel (A, B, C, D or E)- (Not
Mark one A B C D E
applicable to private hostels)
7. Does the hostel have a kitchen providing meals to Mark one Yes No
boarders?
8. Does the hostel have a laundry? Mark one Yes No

1. Is clothing washed? Yes No

2. Is linen washed? Yes No

9. Those hostels with a laundry: 3. Is washing done by machine by hand

4. If washing is done by hand, is it done by

Boarders? Institute workers?

10. What is the capacity of the hostel? Boys Girls Total
11. Indicate the current occupation Boys Girls Total

12. Number of rooms and blocks occupied Rooms Blocks

Boys
Girls
Rooms Blocks
13. Number of rooms and blocks empty & reason(s) Boys
(Attach separate page for reason) Girls
The information stated in this questionnaire is certified as correct.

Superintendent : --------------------------------------- -------------------------------

Signature date
Date Stamp

Principal : --------------------------------------- -------------------------------

Signature date

14. Collection of hostel fees. (only for GRN hostels)

1. Number of boarders granted 20% or less discount

2. Number of boarders granted more than 20% discount.

3. Number of boarders granted total exemption

H2. Hostel Information

15. Number of boarders living in the hostel

The number of boarders living in the hostel must be listed according to the school and grade they are in.

The school(s)’s name(s) are stated in the first column of the table on this page for each school, list the
grades boarders are in under “grade”. State the number of male and female boarders and the total in the
last three columns as indicated. Add the numbers of boarders in the last line. Leave the second column
(“School code”) open.

Example:

Number of boarders living in the hostel:

Name of school attended by School Number of boarders

grade
boarders code Male Females Total

TOTAL

Number of boarders living in the hostel:

Number of boarders
Name(s) of school(s) attended by boarders School code Grade
Males Females Total

TOTAL
H3. Hostel Information

16. Number of hostel staff and numbers of dependents and non-essential boarders living in hostel

The number of all hostel staff whether living in the hostel or not must be reported in the three columns under
“Number of staff WORKING in hostel”. This includes staff on leave and if applicable, relief staff. Full
particulars of each staff member are to be reported.

The numbers of hostel staff of each post level and their dependents (spouses and children), living in the hostel
must be reported in the four columns under “Number of staff and dependents LIVING in hostel”.

Other: Non-essential boarders are people, such as teachers, living in the hostel, but not working there and
not being dependents of hostel staff members already reported elsewhere in the table.

Number of staff Number of staff and dependents

WORKING in hostel LIVING in hostel
Post
Hostel staff Dependents living in
Males Females TOTAL living in hostel hostel TOTAL
(or other staff living in
399) Spouses Children hostel

301 Superintendent
303 Supervisor
304 Chief Hostel Matron
305 Catering Matron
306 House Hold Matron
307 Child Care Matron
308 Senior Institution Worker
309 General Institution Worker
310 Laundry Institution Worker
399 Other Hostel staff (specify)

TOTAL

17. Staff particulars

Particulars of all staff members, including staff on leave and relief staff, are reported in table 17. The
number of staff listed must agree with the numbers reported as “working in hostel” in Table 16 above.

The “post presently held” and “appointment” must be indicated by codes from the tables below. Mark the
staff member’s sex (male or female) and indicate whether or not the staff member is on the state’s payroll
under “paid by”.

CODES

Post presently held Appointment

301 Superintendent 1 Permanent

303 Supervisor 2 On probation
304 Chief Hostel Matron 5 Relief Staff
305 Catering Matron 6. Contract appointment
306 Household Matron
307 Child Care Matron If no appropriate code appears in these tables, indicate
308 Senior Institution Worker the post and / or appointment in the margin and leave
309 General Institution Worker the space for the code open.
310 Laundry Institution Worker
399 Other Hostel staff
H4. Hostel Information

Names and details of hostel staff

Surname Initials Nationality Appointment Paid by ID Number/ DOB Employee code
(code)
Sex
Post
No.
code
M F State Non-
state