Questionnaire Text

Questionnaire form view entire document:  text  image

Date of Birth
7) Mark the number of the month of birth (01 to 12). If the person doesn't know their birth month, mark a line.
Month number _ _

8) Mark the year of birth. If the person doesn't know his month of birth, mark a line in column 8 and mark the estimated age in column 9.
Year _ _ _ _
Questionnaire instructions view entire document:  text  image

a) Columns 1 to 16:

Fill out for each person.

First take inventory of all the people to mark by filling out columns 1 to 6 for each person. Next ask the other individual questions (columns 7 to 25), filling out line by line.


Column 7 and 8: Date of birth:

Mark the month of birth in numbers in column 7 and the year of birth in numbers in the column 8.

[Month numbers and examples omitted]

If someone doesn't know their month of birth, mark a line in column 7 and mark their year of birth in column 8.

If someone doesn't know either their month of birth or their year of birth, mark a line in column 7 and 8 and go on to column 9