Details of the person filling the form:

Designation: ______

How long are you in touch with this area? ______

Fill the information according to your first hand experience with a particular rural area.

Location: ______Population of the area: ______

Locate and identify the home of the preferred respondent. Interview an adult member of the household. Ensure that you interview equal number of males and females.

Details of the Interviewee

Address
Block/District
Caste and Religion

Ask the following questions and enter the information

1. Please give details about the members of your household. (Begin the table by entering the name of the head and underline the name of the respondent.)*

S.no. / Name (optional/ write only initials) / Relation with head / Male/Female / Age / Education level / Occupation
1
2
3
4
5
6
7

* S.no. of each family member will serve as their ID no, enter it in the subsequent questions while referring to the corresponding family member.

2. Is anybody in the family currently enrolled in school (Sc), college (C) or university (U)?

#
(enter s.no. from Q.1) / Male family members / Female family members
Sc / C / U / Sc / C / U

3. How well can your family members speak (S), understand (U), read (R) and write (W) in different languages? Fill the table according to the rating scale given below.

1------2------3------4------5

Not at all May be OK Quiet well Very well

#
(enter in same sequence as Q.1) / Hindi / English / Others, please specify ______
S / U / R / W / S / U / R / W / S / U / R / W
1
2
3
4
5
6
7

4Who all in your family want to learn about the following? Place a tick mark across the topic and enter the s.no. of the family member.

Topic / Male family members* / Female family members
a)Computers and Internet
b) English competency
c) Maths
d) Science
d) Efficient use of mobile
e) Others, please specify ______

5. What are the different areas in which you/ your family members want educationalinformation? Place a tick mark across the topic and enter the s.no. of the family member.

Topics / Male family members / Female family members
a) Computers/Internet
b) Engineering
c) English
d) Maths
e) Science
f) College/University - Admissions procedure, fees, hostel facilities
g) Others, please specify ______

6. From which sources are the educational information obtained by the different family members?Place a tick mark across the source and enter the s.no. of the family member.

Sources of information / Male family members / Female family members
a) Local person
b) Communication with family/friends/ relatives staying in cities
c) Personal visit
d) Media – television/newspaper/ magazines/bulletin board
e) Postal mail
f) Telephone
g) Internet
h) Village knowledge centre/ Information kiosk
i) Community centre
j) Others, please specify ______

7. On an average how much does your household currently spendmonthly on finding educational information? ______Rupees

8. On an average how much your household can spendmonthly for finding educational information? ______Rupees

9. How much has your household spent monthlyon education (including fees, travel, tuitions)?______Rupees

10. What are the other areas in which your family wants more information? Place a tick mark across the area in which the information is required and enter the s.no. (refer Q.1) of the family member.

Topics / Male family members / Female family members
a) Jobs / In the local area
In nearby towns
In nearby cities
In metro cities
b)Farming / Market prices to sell produce
Farming practices/ fertilizers/crop disease
Purchasing equipment
c) Animal husbandry / Market prices to sell produce
Fodder
Rearing practices/ animal disease
d) Mills / Market prices to sell produce
Purchase machinery
e) Legal / Government schemes – e.g. rural employment guarantee scheme, loan waiver
Government documents- e.g. birth/death/marriage certificate
Payment of taxes
f) Banks / Micro-credit/loan
Saving schemes
g) Insurance / Medical/ life/accident
h) Health –
self care / Hygiene
First aid
Self care (beauty)
i) Others, please specify
______

11. On an average how much does your householdcurrently spendmonthly on finding the above information?______Rupees

12. On an average how much your household can spendmonthly for finding this information? ______Rupees

13. How many of the following does the area have? What facilities are provided? Tick in the box of each facility that is available.

Information centre / Number / Facilities
Phone / Mobile / Computer / Internet / Xerox machine / Health clinic / Micro-credit / Others, please specify ______
a) Village knowledge centre/ Information kiosk
b) Community centres
c) Cyber cafes
d) Computer training centres

14. Which of the following information centres do the male and female family members use? Place a tick mark across the information centre used and enter the s.no. (refer Q.1) of the family member.

Information centre / Male family members* / Female family members
a) Village knowledge centre/
Information kiosk
b) Community centres
c) Cyber cafes
d) Computer training centres

15. What services of the information centre do the male and female members of your family use?Place a tick mark across the service used and enter the s.no. (refer Q.1) of the family member.

Services / Male family members* / Female family members
a) Training
b) Apply for government documents
b) Obtain market prices to sell farm products
c) Find employment
d) News
e) Obtain health related information
f) Others, please specify
______

16. In which languages are the services of the information centre used by male and female family members? Place a tick mark across the language accessed and enter the s.no. of the family member.

Languages / Male family members* / Female family members
a) English
b) Hindi
c) Others, please specify ______

17. How much does your family spend on an average monthly for using services of information centre? ______Rupees

18. How many of the following items do your household own? Which items are owned by male and female family members? Which items are used by male and female family members?

Owned by / Used by
Item / Number / Male
family members* / Female family members / Male family members / Female Family members
1 / Electricity
2 / Radio
3 / Telephone – Landline
4 / Telephone – WLL
5 / Mobile telephone
6 / Television
7 / Cable TV
8 / Newspaper
9 / Computer
10 / Internet connection
11 / Bicycle
12 / Two-wheeler
13 / Tractor/truck./car

* Refer Q. 1 and enter s.no.

19. For how many hours per day does your household receive electric supply? ______

20. How much did your family spend on acquiring the following? What is the average monthly outlay of maintaining them?

Item / CAPEX / OPEX
1 / Electricity
2 / Radio
3 / Telephone – Landline
4 / Telephone – WLL
5 / Mobile telephone
6 / Television
7 / Cable TV
8 / Newspaper
9 / Computer
10 / Internet connection
11 / Bicycle
12 / Two-wheelers
13 / Tractor/truck./car

For the families that own WLL phone/ mobile/computer/ Internet connection:

21. What are the phones, mobiles, computers and Internet used for by male and female family members? Place a tick mark across the purpose of use and enter the s.no. (refer Q. 1) member.

Purpose of use / Male family members / Female family members
WLL Phone / Mobile / Computer / Internet / WLL
Phone / Mobile / Computer / Internet
a) Contacting family/
friends/
relatives
b) Education/ Training
c) Finding employment
d) Conduct business
e) Obtaining market prices to sell farm products
f) Transfer of funds from family members working at distant location
g) Entertainment
h) News
i) others, please specify
______

For the families that own a mobile phone:

What features of the mobile phone are used by male and female family members? Place a tick mark across the features used and enter the s.no. (refer Q. 1) of the family member.

Features used / Male family members / Female family members
a) Receiving and making calls
b) Receiving and sending SMS
c) Listening to radio/ music
d) Clicking photographs
e) Making calculations
f) Setting an alarm
g) Downloading ring tones
h) Surfing Internet
i) Checking e-mail
e) Others, please specify ______

For families having at least one male/female computer literate family member:

23. What does the family member use the computer/Internet for? Place a tick mark across the topic used and enter the s.no. (refer Q. 1) of the family member.

Purpose of use / Male family members / Female family members
a) e-mail / communication with family/friends/relatives
b) Education/ training
c) Find employment
d) Conduct business
e) Entertainment
f) News
g) Get agricultural information
h) Book train tickets
i) Others, please specify______
  1. What kind of computer training has your family member received? Refer Q.1 to enter s.no. while entering the details.

Male family members / Female family members
How long? (duration)
How much? (cost)
Where? (location)
What? (content covered)

1