APPENDIX 1 / 6

DEMOGRAPHIC PROFILE

NAME : 1._______________
2._______________
NATURE OF RESPONDANT/RESPONDANTS:

AGE GROUP:
A) 15-25
B) 25-35
C) 35-45
D) 45-55
E) 55-65
F) 65-75

GENDER:Male Female

EDUCATIONAL QUALIFICATION
1. Illiterate
2. Upto 10th
3. Upto 12th
4. Graduated
5. Ungraduated

OCCUPATION :1._________________
2._________________
 APPENDIX 2 / 6

MONTHLY INCOME :

1. 5000-15000
2. 15000-25000
3. 25000-35000
4. 35000-45000

GENERAL QUESTIONNAIRE

QUES1How many members are there in your family ?

No of Households

Total Population
Male Population
Female Population

QUES 3How many children are ther in your family? YES/NO

Do they go to school? YES/NO
PUBLIC / PRIVATE _______________
QUES 4Do you have a a bank account ? - YES
NO
Name of the bank ___________________
QUES 5: What percent of income are you able to save per month ? _________
QUES 6: Has any member of your family migrated ?___________
QUES 7:Do you agree that drainage facilities are proper in the village ?
Agree ____
Neutral________
Disagree _____
 APPENDIX 3 / 6

QUES8: Which health centre do you prefer at the time of medical emergency ?
Public / Private

QUES9: Have you observed any developmental changes in the village lately?
Mention

QUES 10: Mention any issues being faced by you in the village?
 APPENDIX 4 / 6
TOPIC: TO STUDY THE TRANSPORTATION FACILITIES IN THE
VILLAGE

1. Do you own any private vehicle? YES / NO

If yes, How many? _______
Name
 BIKE
 CAR
 TRACTOR
 CYCLE
 SCOOTER / SCOOTY

2. Do you use the private vehicle which you own ? – YES / NO

If no, why not ?________________

3. Which transport do you prefer more?

PUBLIC / PRIVATE

4. How often do you use public transport?

 Daily
 Several times a week
 Weekly
 Several times a month
 APPENDIX 5 / 6

5. For what reasons do you use public transport?

 Schooling
 Job
 Medical
 Household shopping
 Family visits
 Places of worship
 Any other ____________________

6. What is the route you travel the most ?

__________________________________________________________

7. What is the minimum fare you have to pay for the matador ?
_____________

8. For how long do you have to wait for the vehicle on an average?
 15-20 minutes ______
 About an hour ________
 1-2 hours ____________
 2-3 hours ____________
 More than 3 hours____________

9. How many members of your family use public transport ? __________

 APPENDIX 6 / 6

10. Do you face the following problems regarding public transport ?

Do you agree the following schemes

should be launched in the village?

 Overloading
 Waiting time
 Only Matadors and no other means
 Distance to be walked to catch the matador

Which problem according to you is the most critical?_______________-

Any other problems

11. Do you have a vehicle insurance ? __________

Do you agree that vehicle insurance is important ?
Strongly agree ______________
Neutral____________
Strongly Disagree___________

12. SCHEMES
 PradhanMantri Gram ParivahanYojana

PRADHAN MANTRI GRAM SADK YOJNA

How much do you agree on the following ?

Roads of your village are well connected to
other nearby villages