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Institution Template 2 -Form Fill
Information
Q01
Name of the Enumerator
Q02
Name of Supervisor
Q03
Date of Survey
Q04
Institution Type
Residential Institute/Hostel for Student
Monastery/Nunnery/Tantric Institution
Residential School for Children
Senior Citizen Home
Special Needs School
Q05
Institution Name
Q06
Institution Address
Q07
Country
India
Nepal
Q08
Specify school Category
STSS
TCV
THF
SLF
Others (specify)
Q09
Specify institution Category
Vocational Training Center
Higher Education Institution
Hostel for Tibetan Student
Others (specify)
Q10
Specify school of practice of Monastery
Nyingma
Kagyu
Sakya
Gelug
Bon
Jonang
Bhodhong
Bhulug
Remey
Others (Please Specify)
Q11
Respondent Name
Q12
Respondent Job / Description
Q13
Number of Tibetan residents in the Institution
Member Details Questionnaire
A01
Institution Member ID
A02
Member Name
A03
Birth Country
India
Tibet
Nepal
Other (specify)
A04
Sex
Male
Female
Prefer not to say
Other
A05
Ethnicity
Tibetan
Non-Tibetan
Mixed Heritage
A06
Religion
Buddhism
Bon
Islam
Hinduism
Christianity
Non-believer
Other
A07
Year of Birth
A08
Highest Education Level Attained
Pre-primary stage 1-3 & KG
Grade 1-5
Grade 6-10
Grade 11-12
12th pass
Diploma before graduation
Graduate
Diploma after graduation
Postgraduate
PhD
Monastic education
No formal education
Under-age children not going to school
Monks & Nuns with no formal education
A09
can she/he read and write
Read and Write
Read only
None
A10
Marital Status
Never married
Married
Separated
Divorced
Widowed
Other
A11
Primary Occupation
Unemployed
Business (excluding Tibetan Traditional Arts & Crafts)
Agriculture and allied activities (livestock, poultry etc)
Retired
Tibetan Traditional Artisan
Other (Please Specify)
A12
If she/he has pension
Yes
No
A13
Is she/he a Person with Disability (PwD)?
Yes
No
A14
categorize disability
Locomotor Disability
Visual Disability
Hearing Disability
Speech & Language Disability
Mental Retardation & Intellectual Disability
Mental Illness
Multiple Disabilities
Other Disability
A15
does she/he have disability certificate?
Yes
No
A16
in your opinion list the most beneficial CTA services received by you in the past one year
Monthly Stipend
Aids and Appliances
Medical Reimbursement
Telepsychiatry Service
Emergency Psychiatric Treatment
Not Received
Don’t Know
A17
name any new services that you feel would be most beneficial to you
A18
Does she/he have health insurance?
Yes
No
A19
specify insurance type
TMS (CTA)
Ayushman (GoI) or GOI insurance
Private
Army
Other (Specify)
A20
Enter the Greenbook Number
A21
Enter the Greenbook Number of one of the parents
School Graduate (XII Passed) / College Education Questionnaire
B01
Institution Type
Residential Institute/Hostel for Student
Monastery/Nunnery/Tantric Institution
Residential School for Children
Senior Citizen Home
Special Needs School
B02
Institution Name
B03
Institution Address
B04
Member ID
B05
Stream/Course Name
B06
University / College / Schools Name and place
B07
Region
Abroad
Domestic (India or Nepal)
B08
Scholarship Category
CTA Funded
Other Scholarship
Own Funding
B09
If Other scholarship is selected, Specify scholarship
B10
Course Completion year
Mortality Detail Questionnaire
C01
Institution Name
C02
Institution Address
C03
Were there any deaths in the Institution since January 2020?
Yes
No
C04
How many residents died since January 2020?
C05
Gender
Male
Female
others
C06
Age in years at the time of death
C07
Year of death
C08
Place of Death
C09
Enter the Greenbook Number of the deceased
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