(INFORMATION COLLECTED AT THE END OF THE FOCUS GROUP)
TO09 Information Sheet
Focus Group _______
Thank you for participating in today’s focus group. Please complete the following information sheet so we may better understand your household characteristics.
How many people are living or staying in your household including yourself? ______________
For each person who lives in your house, please tell me their relationship to you and their age and in which country they were born and their race or origin. You don’t have to write their names, just their relationship to you. If there are more than five persons, just complete the information for 5.
For example if you live with your husband, you might write: Husband, 43, male, USA
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What is their relationship to you? |
What is their age in years? |
Are they Male or Female |
In what country were they born? |
Person 1 |
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Person 2 |
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Person 3 |
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Person 4 |
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Person 5 |
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Do you or someone in your household rent or own your home?
a. Own ______
b. Rent ______ Does your landlord live in the same [residence] as you? Yes/No
Is there anyone else who stays at your home sometimes, a child with shared custody, someone who lives in a nursing or residential home or a friend who crashes on the couch or stays part time?
Yes—What is their relationship to you? _______________
No
What is the ID number assigned to you during today’s discussion?
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| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Leticia Esther Fernandez (CENSUS/CSM FED) |
| File Modified | 0000-00-00 |
| File Created | 2021-01-28 |