Survey Questionnaire

Topics: UCI race classifications, Tour de Georgia, Status attainment Pages: 3 (559 words) Published: February 24, 2015
Survey Questionnaire

Direction: Please fill in the blanks or check the boxes or parentheses provided below that best correspond to your answer

SOP I. Personal Profile
1.1 Name: (optional):_______________________
1.2 Age
___0-15 years old or below___46-60 years old
___16-30 years old___60 years old or above
___31-45 years old
1.3 Civil Status
___Single___Separated
___Married___Widow/er
1.4 Number of Dependents:
___4-6___10 or above
___7-9
1.5 Educational Attainment
___Elementary___College Graduate
___High-school___vocational

1.6 Occupation
___None___Regular
___Contractual___Others (Please specify)________________
1.7 Average monthly earnings
___ 2,500 Php or below___ 7,501-10,000 Php
___2,501-5,000___10,000 Php or above
___5,001-7,500 Php

1.8 Assets owned
___ Television___ Washing machine
___Electric fan___Gas stove
___Computer___Others (please specify)___________________

1.9 Cash Grants Received
___500 Php___1,100 Php
___800 Php___1,400 Php or more
Part II. How do the beneficiaries allocate in their daily living the following:
2.1 Monthly income
2.2 Cash Grants from the 4Ps
2.1 Where do you spend your monthly income?
___Food___Health
___Shelter___Clothing
___Education___Others (please specify)____________________

2.2 Where do you spend your Cash Grants from the 4Ps?
___Health care program___Others (please specify)____________________ (Note: Specific questions about how the beneficiaries allocate their earnings and cash grants will be asked during the interview) PART III. How does the DSWD monitor the progress of the beneficiaries of the program in terms of:

3.1 Following the condition
3.2 Alleviating from poverty
3.3 Health status
3.4 Education status
3.5 Maternal health
3.1 How often does the DSWD monitor your progress during the 4Ps program? ___Regularly___Frequently
___Seldom

PART IV Based on the recipient’s...
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