Questionnaire Text

Questionnaire form view entire document: text image

(Only for those 5 years of age or older)

10. Are you able to read and write?

[] Yes
[] No

Questionnaire instructions view entire document: text image

Question 10

-- Does the person know how to read and write?

When the person is capable of reading and writing a simple paragraph in any language the answer should be in the affirmative.