Social

1. What is the highest degree or levels of school have you completed?

 No schooling completed
 Below high school diploma
 High school diploma
 Some college, but no degree
 Associates degree
 Bachelor’s Degree
 Master’s Degree
 Professional’s Degree
 Doctorate
2. How would you rate the spaces between the houses in your community?
 Congested
 Partially Congested
 Not congested
3. Are there any factories, warehouses, construction sites, or dump sites near your community?
 None
 Yes, pls specify (chemical factory, gas tanks warehouse, etc.)
___________________________
4. Which of the following types of homes best describes where you currently live? [CHECK
ONLY ONE]
 Single family house
 Two family house that has two separate living units
 Townhouse or row house
 Apartment
 Condominium or coop
 Mobile home
 Senior housing or assisted living facility
 Some other type of living arrangement, pls specify________________________
5. Would you rate your community as, very good, good, fair, or poor on having the following?
A. . Home modification
and repair contractors who are trustworthy, do quality Poor fair good VG
work, and are affordable

B. Well-maintained homes and properties

C. Kind neighbors whom you can easily talk to

6. How would you rate the social status of your community

  Lower class
 Middle class
 Upper-middle class
 Upper class
7. How much do you earn per month?
 > P5,000
 P5,000- P10,000
 P10,000-P20,000
 >P30,000
8. Is your monthly earnings enough to supply the needs of your family?
 Yes
 No
9. How many people are working in your family?
 None
 1
 2
 >3
10. How many are unemployed or underemployed?
 None
 1
 2
 >3
11. Are you satisfied with you current living situation right now?
 Yes
 No
Why? Please specify.
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____________________________________________________________________
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12. How many family members have been pregnant and has given birth?
 1
 2
 >3
13. Does any of your family members have diseases, like hypertension, diabetes, and
tuberculosis? How do you provide solutions for it?
___________________________________________________________________________
___________________________________________________________________________
14. Do you allot funds for your family’s health expenditures? If yes, how much and why? If no,
why?
___________________________________________________________________________
___________________________________________________________________________
15. This last question may be personal, you may choose not to answer it. How long is usually the
life expectancy of your family members?

___________________________________________________________________________
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