Questionnaire - Measurement, Learning & Evaluation Project

Q1011Q1012Q1013Q1014Q1015What is the name and cell phonenumber (if possible) of someone elsewithin your household?Menene sunan wani/wata a cikinwannan gidan da kuma lambar wayarhannun sa/ta (in da akwai)?What is the name, location (addressand description), and cell phonenumber (if possible) of someoneoutside of your household?Menene suna, da wurin (adireshi dakwatancen) da lambar wayar hannu (inda akwai) na wani/wata wandabaya/bata gidan ku?What is the name, location (addressand description), and cell phonenumber (if possible) of another personoutside of your household?Menene suna, da wurin (adireshi dakwatancen) da lambar wayar hannu (inda akwai) na wani/wata kuma wandabaya/bata gidan ku?Other than this place of residence(house), where else does thehousehold head frequently stay? Isthere a phone number and contactperson there?Banda wannan wajen zaman (gidan)ina ne inda maigidan nan ya/ta fiyawan zama?Akwai lambar waya da wanda za asamu a wajen?Do you have an email address forcontacting you?Kina da adireshin lambar yanar gizo daza a iya samun ki?NAME: _________________________CELL NUMBER: [ __|__|___|___|___|___|___|___|___|___|___|RELATIONSHIP TO RESPONDENT_____________________________NAME: _________________________LOCATION:_____________________________________________________CELL NUMBER: [ __|___|___|___|___|___|___|___|___|___]___]RELATIONSHIP TO RESPONDENT_____________________________NAME: _________________________LOCATION:_____________________________________________________CELL NUMBER: [ __|___|___|___|___|___|___|___|___|___]___]RELATIONSHIP TO RESPONDENT_____________________________OTHER RESIDENCE ___________________________________PHONE NUMBER _____________________________________CONTACT PERSON THERE __________________________________YES…………………………………………………………………………………….1EMAIL ADDRESS ________________________________________________NO………………………………………………………………………………………2RECORD END TIME.HOUR……………………………….[__|__]MINUTES…………………………..[__|__]COMMENTS:END THE INTERVIEW AND THANK THE RESPONDENT FOR HER TIME AND PARTICIPATION.46