Survey Log
Day: M T W Th F Sa Su Date: _____ / _____ , 2013 Surveyor: _________________________________________
Inter- viewer initials |
Time |
Already rec'd Q. (Y or N) |
Refused √ |
Gender of participant |
First time visiting CALO? (Y/N) |
Zip Code |
Group size |
Respondent # |
Reason for refusal
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Male |
Female |
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Please provide your contact information. This information will only be used to follow-up with all non-respondents. |
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Name |
Mailing address |
OR |
Email address |
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OMB Control Number 1024-0XXX
Current Expiration Date:
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Ponds, Phadrea |
File Modified | 0000-00-00 |
File Created | 2021-01-29 |