03.10.2017 Views

Food Consumption Patterns Part 2

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151<br />

Consumer Quantitive Questionnaire<br />

Enumerators name*<br />

Hello. My name is _______. I am working for a company that is studying foods. We would like to<br />

ask you some questions about food. Do you agree to respond to the questions?*<br />

ok<br />

Respondent's name<br />

First Name*<br />

Telephone number<br />

tel 1*<br />

tel 2*<br />

Sex of respondent*<br />

male<br />

female<br />

Estimate her/his age*<br />

Where are you from?<br />

Department*<br />

Where were you mostly brought up?*<br />

Port-au-Prince mtro area<br />

City in the provinces<br />

Peri_Urban<br />

Town<br />

Country<br />

Department*<br />

Neighborhood*<br />

Port-au-Prince mtro area<br />

City in the provinces<br />

Peri_Urban<br />

Town<br />

Country<br />

What class did you finish?*<br />

Kindergarten<br />

1st_Grade<br />

2nd_Grade<br />

3rd_Grade<br />

4th_Grade<br />

5th_Grade<br />

6th_Grade<br />

7th_Grade<br />

8th_Grade<br />

9th_Grade

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