Research Metheodology Questionnaire

Government of India

MINISTRY OF INFORMATION & BROADCASTING (CRS CELL)

Community Radio Survey Questionnaire

Respondent Number

PART A: SOCIO-ECONOMIC AND DEMOGRAPHIC PROFILE

Name of the Respondent:

Address:

1.|Sex: 1.Male|2. Female|
3.|Religion:||4. Cast:|
5.|Do you have a Phone:|
1. Yes.|2. No|
If yes, Number:|||

7. Does your Mobile Phone have a Radio?

8. Do you have transport?

1.|Car|2.Jeep|3.Tractor|
4.|Bullock Cart|5. None|

9. Education of the respondent:

Instruction: TICK ONLY ONE

1. Illiterate

2. Literate but no formal education 3. School up to 5 years (Class1-5) 4. School up to 6-9 years (Class 6-9) 5. SSC/HSC

2. Age (in completed years)

6. Do you have a Mobile:

1. Yes. 2. No

If yes, Number:

1. Yes. 2. No

10. Occupation of the respondent Instruction: TICK ONLY ONE

1. Farmer

2. Wage labourer 3. Skilled worker
4. Petty Trader(shop keeper) 5. Self employed

1

6. Under Graduate||6. Service – Government||
7. Graduate /Post Graduate (General)|7. Service Private||
8. Professional (Doctor, Engg, LLB,MBA)|8. Homemaker||
9.Technical (Diploma/IT)|||
|9. Student||
10 Others (Specify) _______________|||
|10. Retired||
||||
||11. Unemployed||
||12. Others||
11. Does the respondent’s house have electricity? Instruction: OBSERVE AND WRITE||
1. Yes.|2.No|||
12. Type of House||13. Where do you get your Drinking Water?||
Instruction: OBSERVE AND TICK ONE|Instruction: TICK ONLY ONE||
1. Hut||1. Tap in the House||
2. Semi Pucca||2. Common Tap||
3. Pucca||3. Hand pump / Bore well||
4. Apartment||4. Well||
5. Independent house/Bungalow|5. Tank/ Pond||
||6. Others: (specify):_____________||
14. What type of cooking fuel do you use|15. What toilet arrangements do you