Questionnaire Text

Questionnaire form view entire document:  text  image

2. Relationship to the head of the family:
Mark the box corresponding to the relationship of the person to the head.

1st Person 1
[] Head

2nd Person
[] 2 Spouse or partner
[] 3 Son
[] 4 Other relatives
[] 5 Other

Questionnaire instructions view entire document:  text  image

(Applicable to persons of all ages)
(Questions 1-10)


Question 2 Relationship to the head of family.

Mark the corresponding box in agreement with the relationship or relation with the Head.