Take Survey - CIG NG

My Personal Information

Phone:

Gender:

Male Female

Surname:

Other Names:

Do you have a Birth Certificate:

Yes No

Official Birth Certificate?

Date of Birth:

Name of Parents

Do you have a NIMC Number:

Yes No

Place of Birth:

Include the name of the Hospital and its location

State of Residence

LGA of Residence

Do you have Voters Card:

Yes No

Status of Parents (Orphan)

State of Origin

LGA of Origin

Religion:

Marital Status

Employment

Occupation or Job Designation:

Talent, Hobbies and Skills (Seperate with Commas, ):

Language / Dialect (please specify):

Socioeconomic Demography

Do you have legal right to any land? :

Yes No

How long have you being in this your occupation?

How many people live in your household?

What is your monthly income from your occupation?

How much (total amount) did you realise from your main occupation last year (Naira)?

Kindly rank the following in order of importance to health needs in your community

Activity	Very Important	Important	Least Important
Provision of health facility with necessary equipment and personnel
Supply of adequate drugs to the existing health facility
Recruitment of more professional staff
Provision of social infrastructure to encourage health personnel settle down in the community
Sensitization of community members on personal hygiene
Increasing the community members knowledge about available health resources
Training of women on early childhood nutrition/nutritional counselling
Provision of health scheme for aged persons
Provision of affordable and accessible health care services to all

Educational Survey

Activity	Strongly Agree	Agree	Disagree	Strongly Disagree
Provision of decent and conducive classrooms with adequate teaching aids
Provision of decent and conducive work environment for teachers
Making education affordable and accessible to all child(ren) particularly to children under 12 years though provision of free textbook and tuition free
Using indigenous languages as communication tools as stated in 2014 education policy
Providing pupils with free school feeding programme
Preschool activities for child(ren) to develop school readiness skills
Affordable transportation options to and from school
Affordable high-quality childcare options for parent who would like to further their education
Renovation of existing schools to make it conducive for reading
Granting scholarship to students to encourage them further their education
Recruitment of more teachers and re-training of the existing ones
Establishing STEM (science, engineering, technology, and mathematics) programmes for pupils.
Focusing good relationships and encouraging friendship clubs in schools.
Review of school curriculum to match current and future development needs realities

Social Investment and Empowerment

Do you belong to any association/group

Yes No

Are you in any group?

If yes, tick the association/group you belong to (multiple responses allowed):

Women group Youth group Religious group Age grade group Trade professional association Savings group
Others, Please Specify:

Do you have a school feeding programme in any primary school in your community?

Yes No

If yes, how many times are they fed in a week?

Kindly rate the following as most important empowerment needs in your community.

Activity	Very Important	Important	Least Important
Establishment of Youth Vocational Training Centre
Entrepreneurial training for business/skill management
Financial support for trained youths to start business
Mentorship for young entrepreneurs
Early reinforcement of the values of enterprise/job creation/self-reliance
Increasing the community’s knowledge on available opportunities in their locality
Up-dating of the existing skills in line with technological development for greater efficiency
Provide financial support in form of loan to existing artisans, traders, farmers, commercial drivers and civil servant at low or free interest rate
Linking producers/farmers to market facilities
Organising farmers into group(s) for direct/easy/timely access to farm inputs
Creating industrial parks and special economic zone
Creating a processing centers for the major economic activities in the zone

Citizens Inclusion in Governance. A National Survey.

My Personal Information

Educational Status

Health Support (Life saving in cases of Emmergency )

Financial Support

Personal need Assessment

Socioeconomic Demography

Health Survey

Educational Survey

Social Investment and Empowerment

Social Infrastructure

Political / Community development