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Name
   
 
 
 
Group name
   
 
 
 
Sex
 
male
 
female
 
 
 
Date of birth or age:
   
 
 
 
Level of education:
 
none
 
basic
 
JHS
 
SHS and beyond
 
 
 
Marital status:
 
married
 
single
 
widow(er)
 
divorced
 
 
 
Number of dependents:
males
females
0
 
 
 
a. Dependent name:
   
age/DOB:
   
In school?
   
level:
   
b. Dependent name:
   
age/DOB:
   
In school?
   
Level:
   
c. Dependent name:
   
age/DOB:
   
In school?
   
Level:
   
d. Dependent name:
   
age/DOB:
   
In school?
   
Level:
   
e. Dependent name:
   
age/DOB:
   
In school?
   
Level:
   
f. Dependent name:
   
age/DOB:
   
In school?
   
Level:
   
 
 
Ownership:
 
Owned
 
Family House
 
Rented
 
Building
 
 
 
Material:
 
mud
 
wood
 
concrete