Date: 16/02/2017

SURVEY ON SOCIAL AND ECONOMIC CONDITIONS OF VILLAGERS

Village Information:

a) Village: __________________________________________

b) Para/Area: ________________________________________

Individual Information:

a) Name of the Respondent:

__________________________________________________

b) Relationship with Household Head: _____________________

c) Religion: __________________________________________

PART I: DEGOGRAPHIC PROFILE

1. Household information (includes information of the respondents in the table):

(include only those members who are living with the household head at present)

Name Age Sex* Marital Status** Relationship Schooling Occupation

with HHH

(* Male M. Female - F), [** Married 1, Unmarried 2, Widowed 3, Other ___ (specify)]
 Date: 16/02/2017

PART II: SOCIAL CONDITIONS

2. What should be the Highest level of education level in Village?

Gender Level of Education No Education

Male
Female

3. If you had to choose between education a child, who would it be?

Son: Yes No
Daughter Yes No
4. What should be minimum age to get married?
Male 10-18 19-27 28- 36 37-45 above
Female 5-10 10-18 19- 27 28-37 above
5. What should be minimum level of education to get married?
Male primary secondary higher secondary university level
Female primary secondary higher secondary university level
(6-12)
Are the female members of the family allowed to perform the following activities?

Activities Yes No
6. Voting
7. Shopping in Village
8. Shopping outside the Village
9. Visiting relatives in Village
10. Visiting relatives outside Village
11. Meeting unmarried male family members
12. Watching TV/DVD/Cinema

13. State Five Positive Changes* which have occurred during the post liberation period
(a)
(b)
(c)
(d)
(e)
*From the respondents point of view.
 Date: 16/02/2017

14. State Five Negative Changes* which have occurred during the post liberation period
(a)
(b)
(c)
(d)
(e)
*From the respondents point of view.
(15-20)
How do you like to spend your free time? (write Y for YES & N for NO)

Activity Male Female

15. Gossiping with Friends
16. Gossiping with Relatives
17. Playing with Children
18. Watching TV
19. Listening to the Radio
20. Others (specify)

PART III: ECONOMIC CONDITIONS

21. What is your source of Income?

Agriculture Agricultural Labor Poultry Cattle/Goat
Small Business/Shop Vendor Transport Worker Service
Construction Worker Garments Worker Industry Other
22. Homestead
Type Roof Wall Floor Entrance
Tin
Bamboo Thatch
Wood
Concrete
Earth
Others

23. Are you a member of an NGO/s? Yes No

 Date: 16/02/2017

24. If YES, which NGO/s? __________________________________________________

__________________________________________________________________________
25. Since when are you borrowing from these NGOs? ________________________________
26. What is the amount of your last loan? ______________________________________
27. What is the interest rate they charging? ______________________________________
28. How have you used this loan?
Bought Rickshaw and Rode myself Bought Rickshaw and Rent it
Selling Dairy Products Cattle Fattening Selling foods at School
Relending Money Establishing Tea Stall Establishing Small Shop
Establishing Business Daughters Marriage Others__________________
** If this borrower has been taking loans for Five years or more, then ask the Questions 29-32
29. Have you improved your economic condition by using Micro Credit?
Yes No
30. If YES, can you manage your household without micro credits? Yes No
31. Do you take NGO oath at times? Yes No
32. Has this changed your Outlook on life and society? Yes No
33. If you are unable to repay your weekly payment what is the action taken by them?
__________________________________________________________________________
34. Did this NGO tell you about proper sanitation? Yes No
35. Did they help you for your childrens education? Yes No
36. Did they help with your familys health? Yes No
37. Did this NGO help in Skill Development? Yes No
38. Did they help in Womens Empowerment? Yes No
39. Did this NGO teach you in Vote? Yes No
40. Did they suggest any party to Vote? Yes No
41. Mention the amount of crop you can store in storage? __________________________
42. Live Stock:
Domestic Animal Number Domestic Animal Number
Cow Goat
Ox Poultry
Others (specify Name & Number):

(Respondents Signature)
## THANK YOU for your cooperation.