You are on page 1of 1

QUESTIONNAIRE

Students Name: ________________________________________________________________________________


Age:

15-18

1 18-21

> 21

Program in which studying: Prog Name _____________________________________ Prog Code _______________


Faculty:

LFBAA

LFTS

LFAMS

LFEH

Year of Admission: ______________


Place to which student belongs:

State __________________________________ Dist. _____________________

Parents Educational
Level:

10th/10+2

Illiterate

Graduate

Post Graduate

Father
Mother
Monthly income from all
sources:

Below Rs 15,000

Rs.15,000-30,000

Rs. 30,000-45,000

Above Rs. 45,000

Father
Mother
Brothers / Sisters
Monthly income from all
sources (if living in joint
family)
Mothers Profession: ____________________________________________________
Fathers Profession: ____________________________________________________
How many brothers/sisters you have?
Brothers: __________

Sisters: _____________

Working: __________

Non-working: ________

Type of Accommodation of family:

Own

Rented

(Appx Area: ___________________)

Vehicles you own:


No. of Two Wheelers: ________

(Make: _________________; _________________; ________________)

No. of Four Wheelers: ________

(Make: _________________; _________________; ________________)

Do you own a laptop?

Yes

No

(Make:_______________________________)

Do you own mobile phone?

Yes

No

(Make:_______________________________)

Are you staying in Hostel?

Yes

No

If Yes, Room Type:


Room Type / Seater

AC
NON-AC

4
X

5
X

If any other (Please specify)__________________________________________________________________________


If NO, tick following
I belong to areas nearby LPU.

I am staying in PG.

I have rented some place.


Thank
s!

You might also like