1. what is your name?
2. sex
3. what is your birthdate?
4. what is your current marital status?
	a. single (never married)
	b. married (first marriage)
	c. Re-merried (following widowhood)
	d. Re-merried (following divorce/annulment)
	e. separated
	f. divorce
	g. widowed
5. Where is your place of birth?
6. Where do you usually live?
7. what is your nationality?
8. what is your religion?
9. how many children do you have (this question is for parents only)
10. do you have any of the following long-lasting conditions or difficulties?
	a. blindness or a serious vision impairment. yes/no
	b. deafness or a serious hearing impairment. yes/no
	c. an intellectual disability.
	d. a difficulty with learning, remembering or concentrating. 
	e. a psychological or emotional condition?
	f. a difficult with pain, breathing or any other chronic illness or condition.
11. If 'Yes' to any of the categories specified in question no. 10, do you have any difficulty in
	doing any of the following?
	a. Dressing, bathing or getting around inside the home.
	b. Going outside the home alone to shop or visit a doctor's surgery?
	c. Working at a job or business or attending school?
	d. Participating in other activities, for example leisure or using transport?
12. how is your health in general?	
	a. Very Good
	b. Good
	c. Fair
	d. Bad
	e. Very Bad
13. How do you usually travel to work, school or college?
	a. not at work, school or college
	b. On foot
	c. Bicycle
	d. Commute via (tricycle/jeep/bus).
14. What time do you usually leave home to go to work or school?
	a. not to work or school.
	b. Before 6am
	c. Before 7am
	d. Before 8am
	e. Before 9am
15. What is the Highest level of Educational Attainment which you have completed?
	a. No formal Education
	b. Elementary Graduate
	c. High School Graduate
	d. Graduate of Vocational Courses
	e. UnderGgraduate(Bachelor's degree)
	f. Graduate (Master's Degree)
	g. PostGraduate (Doctor's Degree)
16. How would you describe your present principal status?
	a. Employed
	b. Unemployed
	c. Student
	d. Retired from Employment
	e. Unable to work due to permanent sickness or disability
17. What is your occupation? (for employed only).
18. Where do you work? (for employed only).
19. What is the Complete Address of your School?