13.07.2015 Views

Download this publication - AIDS Data Hub

Download this publication - AIDS Data Hub

Download this publication - AIDS Data Hub

SHOW MORE
SHOW LESS

Create successful ePaper yourself

Turn your PDF publications into a flip-book with our unique Google optimized e-Paper software.

[ 2 ] Employed full-time, please specify________________________________________[ 3 ] Employed part-time, please specify ______________________________________[ 4 ] Self-employed, please specify ___________________________________________[ 5 ] Long term medical leave[ 6 ] Volunteer work[ 7 ] Others, please specify _________________________________________________7. What is your highest educational level?[ 1 ] No formal education[ 2 ] Completed primary school[ 3 ] Completed lower secondary school (Form 3)[ 4 ] Completed upper secondary school (Form 5 or 6)[ 5 ] Completed vocational school[ 6 ] University / College[ 7 ] Others, please specify _________________________________________________8. Please tell us more about your immediate family members.GrandparentsFamily membersNo. of person_____________ParentsSiblings (excluding myself)MaleFemaleChildren (including adopted child)MaleFemale_____________________________________________________________________9. Apart from you, who is HIV positive in your family? Please specify the relationship(for the child involved, including adopted children, please specify the age if the childis below 18 years old).RelationshipFor child under 18 years old,please specify the age (years)1) ______________________________2) ______________________________3) ______________________________4) ______________________________________________________________________________________________10. Are you dependent on your family members, or are your family members dependenton you? Please tick (√) all that apply.150

Hooray! Your file is uploaded and ready to be published.

Saved successfully!

Ooh no, something went wrong!