Iranian Revolution and Sacred

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Interviewer Name:
Supervisor Name:
Sample No:
Date Completed:
Rural_____________ Urban____________
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City_____________, District _______________Province______________
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1. General Information

Name ________________________________________________________ ____Age _____________

* About Neighborhood [ ] I live in shanty houses/slum [ ] I live in interior city [ ] I live in housing society [ ] Other ____________________

* What language do you speak at home? [ ] Urdu [ ] English [ ] Shina [ ] Balti [ ] brushiski [ ] Other _______________________________________

* Are you married? [ ] No [ ] Yes [ ] if yes, age at the time of Marriage ______ years

* Is your marriage: [ ] Arranged [ ] Your choice

2. Education Related Information

* Education * Never went to school/illiterate [ ] parents could not afford [ ] parents didn’t want * primary up to middle [ ] continuing [ ] dropped out * Matric [ ] continuing [ ] dropped out * Inter [ ] continuing [ ] dropped out * Bachelors [ ] continuing [ ] dropped out * Masters [ ] continuing [ ] dropped out

* Father’s Education Mother’s Education [ ] Never went to school/illiterate [ ] Never went to school/illiterate [ ] Primary up to Middle [ ] Primary up to Middle [ ] Matric [ ] Matric [ ] Intermediate [ ] Intermediate [ ] Degree [ ] Degree [ ] Masters [ ] Masters [ ] Post doc [ ] Post doc [ ] Professional Degree Doctor/Eng [ ] Professional Degree Doctor/Eng

* How did you do / are doing at school? [ ] I