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Questions marked with an * are required Exit Survey
 
 
Name
   
 
 
 
* Age
 
Between 15 Years- 20 Years
 
Between 20 Years- 30 Years
 
Between 30 Years- 49 Years
 
 
 
* Which one of the following best describes your current relationship status?
 
Single
 
Married
 
Widowed
 
Divorced
 
Separated
 
 
 
* Which one of the following best describes your annual household income?
 
Below Ethiopian Birr 10,000
 
Ethiopian Birrr 10,000 - Ethiopian Birr 26,000
 
Above Ethiopian Birr 26,000
 
 
 
* What is the highest level of education you have completed/will complete?
 
Primary Schooling
 
Secondary Schooling
 
Graduation
 
Post Graduation
 
 
 
* How many people including you, are supported by this income?
   
 
 
 
* Did you and your partner ever use contraceptives?
 
Yes
 
No
 
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