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  1. Surveys
  2. 2016
  3. February
  4. R
  5. RCB Nabbah Relief
0%
Questions marked with a * are required Exit Survey
 
 
How many people live in your house?
 
1-2
 
2-4
 
4-6
 
Over 7
 
 
 
* How many male children at home? Under 12 years old.
 
1 ____
 
2 ____ _____
 
3 _____ _____ ______
 
4 ____ _____ ______ ______
 
5 ____ _____ ______ ______
 
6 ____ _____ ______ ______
 
None
 
 
 
 
 
How many female children at home ? under 12 years old.
 
1 ____
 
2 ____ ____
 
3 ____ ____ ____
 
4 ____ ____ ____ _____
 
5 ____ ____ ____ _____ _____
 
6 ____ ____ ____ _____ _____ _____
 
 
 
 
 
How many times do you get milk for your child from our church?
 
Once a week
 
Once every 15 days
 
Once a month
 
none
 
Other
 
 
 
 
How many times do you get milk for your child from other NGO's , Church, or individual?
 
Once a week
 
Once every 15 days
 
Once a month
 
None
 
Other
 

 
 
 
How many members of your family have a job?
 
1
 
2
 
3
 
4
 
none
 
Other
 

 
 
 
* Please give us an approximate of the family income per month:
 
50-100 LP
 
100-300 LP
 
300-500 LP
 
500-800 LP
 
Temporary income ______________
 
Other
 
 
 
 
Does your husband/wife lives with you?
 
Yes
 
No
 
Sometimes
 
 
 
 
Please let us know if you got the following at home:
 
Stove
 
Refrigerator
 
Microwave
 
TV
 
Beds - how many _______
 
Dinning table
 
Living sofa
 
Blender
 
Other
 

 
 
 
* In the past, did you received any mattress, blankets or house supply from our church? if yes how many times?
 
Once
 
Twice
 
Always
 
None