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Questionnaire
Questionnaire
QUESTIONNAIRE
This questionnaire is designed to determine the Acceptability of Kamias fruit as a main ingredient in stain
remover on clothes. Your help will be most appreciated. Please check the appropriate space or write in the
requested information.
PERSONAL DATA:
1. Sex:
male _____
female _____
2. Marital status:
Single _____
married _____
divorced _____
widowed _____
separated _____
3. Number and ages of children in the family, living at home:
_____ no children
_____ have children; ages ____, ____, ____, ____, ____,
Please rate the following stains according to 1) frequency of occurrence and 2) ease of removal; (#1 being
the easiest to remove to #5 being the most difficult to remove).
STAINS FREQUENCY OF OCCURRENCE EASE OF REMOVAL
NEVER SOMETIMES FREQUENTLY 1 2 3 4 5
ketchup
Blood
Permanent
Marker
chocolate
soy sauce
Ballpoint ink
dirt.
Comments:___________________________________________________________________________
_____________________________________________________________________________________
__________
_____________
Signature