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2015
August
H
HH
HH
Tata Institute of Social Sciences,
Mumbai
0%
Questions marked with an
*
are required
Exit Survey
PERSONAL INFORMATION
*
Date and Time of Interview
Month
Day
Year
Hrs.
Mins.
AM/PM
--
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
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31
--
1900
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1907
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1910
1911
1912
1913
1914
1915
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2015
2016
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2019
2020
2021
2022
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2024
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2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
2046
2047
2048
2049
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59
AM
PM
*
Panchayat Name:
-- Select --
Ramtek
Kalmeshwar
Bhiwapur
Mauda
Parseoni
FAMILY BACKGROUND
Sub Caste:
Religion
-- Select --
Hindu
Muslim
Christian
Buddhist
Other
Total Members in the Family:
-- Select --
1
2
3
4
5
6
7
8
9
10
More than 10
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