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Name of the house owner:

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Number of family members

  



Occupation:

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Do you have Vehicle?

 

Type of vehicle.

 
        

Type of roads:

   

Distance of the homes from metalled road (Km) :

    

Availability of health centre in your village

!" #  !" #  $   " %

How are you going to hospital ?

  &    # '"  '

Distance from the house to hospital (Km):

„    

Number of private dispensaries

  (
 Number of farmacy

  ( 

Preference for which hospital:

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From what kind of deseases are you suffering?

How many people are suffering from deseases?

„  (

Are you satisfy by available health centre?

 

Do you have first aid faciliy in your home?

 

Are you using telephone or mobile to call the doctor?

 

Are you using ambulance for serious patients?

 

Number of literate people in your house:

 (  )

    

·ducational qualification and number of people.

* + , + '' 

- .(/

0%  ./

1  % . /



-  %





School distance from the house

2 * , -  3 

- .(/

0%  .
/
1  %
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-  %
 



Type of transportation to get into school

  &

 

  





· penditure on education (annually)

4  







  

Quality of education in village:

- !"%

 25 

Faciliies in school:



6 # %

7

 

& 8#& 

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Have you stopped your doughter͛s education due to unavailability of collage in your own village?

 

If yes , why?

Indivisual suggetion about educational facilities, problems.

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Name of the village:

Taluka: District:

Total area of the village:

Total population of the village:

Number of male population :

Number of female population:

Total households in the village:

Distance of village from the nearest town:

Does the settlement have a school:

Does the settlement have a health centre: