Household Income Range *
-- Select Range --
Below KES 5,000
KES 5,001 – 10,000
KES 10,001 – 20,000
KES 20,001 – 30,000
KES 30,001 – 40,000
KES 40,001 – 50,000
KES 50,001 – 75,000
KES 75,001 – 100,000
Above KES 100,000
Household Size *
Dependents under 18 years of age (including yourself) *
Dependent elderly members above 65 years of age *
Members with disability (if any) *
Describe the disability (for each member) *
Housing Type *
Select
Permanent (Stone/Concrete)
Semi-permanent (Wood/Mud)
Temporary (Shack/Thatch)
Family Home Ownership Arrangement *
Select
Owned
Rented
Provided by employer
Other
Please specify *
Do any of your sibling(s) currently work or earn income? *
Select
Yes
No
Describe the employment (for each sibling) *
Does your household have difficulty meeting basic needs? *
Select
Yes
No
Kindly describe the difficulty *
Have you ever been out of school due to lack of school fees? *
Select
Yes
No
Briefly explain the situation *
Does your family own any land? *
Select
Yes
No
How many acres?