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ANNAMALAI UNIVERSITY

DEPARTMENT OF STATISTICS

A STUDY OF SOCIO-ECONOMIC SURVEY OF


PERIYAPATTU PANCHAYAT

MODEL QUESTIONAIRE

1. Village Name :
2. Head of the Family :
Sex : Male / Female
Age : Years
Religion : Hindu/Musilm/Chirisitian/Others
3. Size of the Family :
Relation
Educational Marital
NAME Sex AGE with Occupation
Qualification Status
Head

4. Family Income :
i. Salary & Wages :
ii. Land :
iii. Business :
iv. Pension :
v. Agriculture :
5. Family Expenditure :
i. Food Exopenses and Others:
ii. House Rent :
iii. Educational Travelling:
6. Did you have any savings : Yes / No
7. Did you have any loan? : Yes / No
If Yes:
Government :
Bank :
Private :
Interest :
8. Type of House :
i. Tatched ii. Tiled iii. Terrace
9. Whether the house is electrified? (Yes / No)
10. Property size own / lease in Rs:
Ground: Land:
11. Water source :
1. Tap 2. Over Tank 3. Community supply 4. Hand pump
12. Family Business : (Yes / No)
If Yes, Name of the Business
13. Which of the following model of cooking you use
1. Gas 2. Power stove 3. Wook
14. Did you have any vehicle?
1. Bicycle 2. Bike 3. Car 4. Others
15. Is there any domestic animals in your house:
1. Cow 2. Buffalo 3. Goat 4. Dog
16. Do you want school educational to your children? (Yes / No)
S.No YES No
1 FREE FOODS IS AVAILABLE TO KEEP CHILDREN FOR
HOUSEHOLD WORK
2 GOOD JOB OPPORTUNITY FOR LACK OF GOOD JOB
OPPORTUNITY
3 TO SHAPE THEM AS GOOD DUE TO FINANCIAL PROBLEM
CITIZEN

17. If Education is necessary for your female children: (Yes / No)


Upto
18. Regarding family planning, did you accept : (Yes / No)

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