DEMOGRAPHIC STRUCTURE

Questionnaire

1. Name:-
2. What is your age?
o 15-25 years
o 25-35 years
o 35-50 years
o 50 years and above
3. What is your occupation?

4. What is your average monthly income?

o Rs.10,000- Rs.30,000
o Rs.30,000- Rs.50,000
o Rs.50,000- Rs.80,000
o Rs.80,000 and above
5. Which religion do you follow?
o Hindu
o Islam
o Sikh
o Christian
o Others
If others, please specify
6. What is your marital status?
o Single
o Married
o Divorced
7. Which group do you belong to?
o General
o SC
o ST
o OBC
8. Which caste do you belong to?
9. What are your educational qualifications?
o Primary education
o Matriculation
o Graduation
o Post-graduation
o PHD
o Illiterate
10. Where is your hometown?

11. If you have moved from your hometown, what is the reason?
o For a job
o For better living conditions
o Something else
12. How many languages do you know?
o 1
o 2
o 3
o 3 and more
13. Which language do you use the most?
o Hindi
o English
o Regional
o International
14. How many members are there in your house?
o You live alone
o 2
o 3
o 4
o 5 and above
15. How frequently do you visit the hospital?
o In a week
o Twice/thrice a month
o In 3-4 months
o Very occasionally
16. Are you fully vaccined?
Yes / No
17. Do you want to shift or move from your locality?
o Yes
o Never
o Maybe
o You want to but you cannot
18. If you want to, why do you want to shift?
o For better job facilities
o For better living conditions
o Others, please specify
19. How long have you lived in your current locality?
o Moved recently (2 -4 months)
o 1-7 years
o 7-15 years
o More than 15 years
20. Are you a part of any welfare regarding associations?
o Yes, I currently am
o I used to be a part before
o No, never