Socio Demographic Questionnaire
A socio demographic questionnaire is developed for purposes of gauging the social status of a specific community or society. The formulated questions are usually subjective in nature and gauge things such as individual educational level, one’s income, assets and occupational status. The questionnaire is also used to identify the respondent’s age, gender, health status and racial group. Such questionnaires are commonly used in national household surveys for purposes of establishing the social status of an identified community. During the construction of the questionnaire, consultations are done to ensure that the survey questions are valid and acceptable in the target community.
Q1. Age ______
Q2. Gender
Male______ female______
Q3. What is your marital status?
Single______ Married______ divorced ______ separated______
Q4. What is your employment status?
Full time employed______
Part time employed______
Self-employed______
Housewife/husband______
Unemployed______
Retired______
Q5. What is your highest level of education?
Elementary school______
High school______
College______
Graduate school______
Q6. What is your degree level?
High school diploma______
Bachelor’s Degree______
Masters______
PhD______
None______
Q6. Where do you live?
In my house______
In my parents’ house______
In a co-owned/rented house______
Q7. How many other people live in the same house with you?
None______
One______
Two______
More than two______
Q8. How many other people in the house earn an income?
All______
None______
Other (specify) ______
Q9. What is your main source of financial support?
My income (paycheck or income from businesses) ______
Family support (including alimony or child support) ______
Unemployment benefits______
Workman’s compensation______
Disability benefits______
Veteran’s benefits______
Social security______
Q10. Do you have any outstanding debts? If so how much are they worth?
No______
Yes______
$500 or less______
Between $500 and $4999______
Between $5000 and $9,999______
More than $10,000______
Category: Social Questionnaire