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English - Freedom from Hunger

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appendix 2. Impact story Questionnaire<br />

Member Details<br />

name of Member<br />

_____________________________________<br />

name of Community<br />

_____________________________________<br />

name of Credit association<br />

_____________________________________<br />

age of Member<br />

_____________________________________<br />

living environment<br />

Peri-urban/semi-urban <br />

Rural <br />

size of first loan _________<br />

size of current loan _________<br />

Total number loans taken _________<br />

Interview Details<br />

First visit<br />

second visit<br />

Third visit<br />

Name of the<br />

Interviewer<br />

Date<br />

DD/MM/<br />

YR<br />

__/___/__<br />

__/___/__<br />

__/___/__<br />

Member Id:<br />

_____________________________________<br />

no. of Months/Years as a Member<br />

______________ OR ________________<br />

(months) (years)<br />

Credit association Id:<br />

_____________________________________<br />

Type of business<br />

_____________________________________<br />

name of Field agent<br />

_____________________________________<br />

Current amount in savings<br />

_____________________________________<br />

Start time<br />

(24-hour<br />

format)<br />

____:____<br />

____:____<br />

____:____<br />

End time<br />

(24-hour<br />

format)<br />

Interview<br />

Successfully<br />

Completed?<br />

____:____ 1. Yes …<br />

2. no. …<br />

____:____ 1. Yes …<br />

2. no. …<br />

____:____ 1. Yes …<br />

2. no. …<br />

aPPendICes<br />

32

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