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DEMOGRAPHIC AND HEALTH SURVEY - 2015 ETHIOPIA - HOUSEHOLD QUESTIONNAIRE (ENGLISH)

ETHIOPIA

IDENTIFICATION

LOCALITY NAME:

NAME OF HOUSEHOLD HEAD:

CLUSTER NUMBER:

HOUSEHOLD NUMBER:

HOUSEHOLD SELECTED FOR FEMALE GENITAL MUTILATION AND DOMESTIC VIOLENCE?

YES 1
NO 2

INTERVIEWER VISITS

FIRST VISIT
DATE
INTERVIEWER'S NAME
RESULT*

1 COMPLETED
2 NO HOUSEHOLD MEMBER AT HOME OR NO COMPETENT RESPONDENT AT HOME AT TIME OF VISIT
3 ENTIRE HOUSEHOLD ABSENT FOR EXTENDED PERIOD OF TIME
4 POSTPONED
5 REFUSED
6 DWELLING VACANT OR ADDRESS NOT A DWELLING
7 DWELLING DESTROYED
8 DWELLING NOT FOUND
9 OTHER (SPECIFY)

SECOND VISIT
DATE
INTERVIEWER'S NAME
RESULT*

NEXT VISIT
DATE
TIME

THIRD VISIT
DATE
INTERVIEWER'S NAME
RESULT*

FINAL VISIT
DAY
MONTH
YEAR
INTERVIEWER'S NUMBER
RESULT*

TOTAL NUMBER OF VISITS

TOTAL PERSONS IN HOUSEHOLD

TOTAL ELIGIBLE WOMEN

TOTAL ELIGIBLE MEN

LINE NUMBER OF RESPONDENT TO HOUSEHOLD QUESTIONNAIRE

LANGUAGE OF QUESTIONNAIRE

01 ENGLISH
02 AMHARIC
03 TIGRIGNA
04 OROMIYA
05 LANGUAGE 5
06 LANGUAGE 6

LANGUAGE OF INTERVIEW

01 ENGLISH
02 AMHARIC
03 TIGRIGNA
04 OROMIYA
05 LANGUAGE 5
06 LANGUAGE 6

NATIVE LANGUAGE OF RESPONDENT

01 ENGLISH
02 AMHARIC
03 TIGRIGNA
04 OROMIYA
05 LANGUAGE 5
06 LANGUAGE 6

TRANSLATOR USED?

YES 1
NO 2

SUPERVISOR
NAME
NUMBER

FIELD EDITOR
NAME
NUMBER

OFFICE EDITOR
NUMBER

KEYED BY
NUMBER

INTRODUCTION AND CONSENT

Hello. My name is ___. I am working with Central Statistical Agency (CSA). We are conducting a survey about health and other topics all over Ethiopia. The information we collect will help the government to place health services. Your household was selected for the survey. I would like to ask you some questions about your household. The questions usually take about 15-20 minutes. All of the answers you give will be confidential and will not be shared with anyone other than members of our survey team. You don't have to be in the survey, but we hope you will agree to answer the questions since your views are important. If I ask you any question you don't want to answer, just let me know and I will go on the next question or you can stop the interview at any time. In case you need more information about the survey, you may contact the person listed on this card.

GIVE CARD WITH CONTACT INFORMATION

Do you have any questions?
May I begin the interview now?

SIGNATURE OF INTERVIEWER ___
DATE ___

RESPONDENT AGREES TO BE INTERVIEWED 1 (GO TO 100)
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 (GO TO END)

100. RECORD THE TIME.

HOURS ___
MINUTES ___

HOUSEHOLD SCHEDULE

1. LINE NUMBER.

___

2. USUAL RESIDENTS AND VISITORS: Please give me the names of the persons who usually live in your household and guests of the household who stayed here last night; starting with the head of the household.

AFTER LISTING THE NAMES AND RECORDING THE RELATIONSHIP AND SEX FOR EACH PERSON, ASK QUESTIONS 2A-2C TO BE SURE THAT THE LISTING IS COMPLETE.

THEN ASK APPROPRIATE QUESTIONS IN COLUMNS 5-20 FOR EACH PERSON.

___

2A. Just to make sure that I have a complete listing: are there any other people such as small children or infants that we have not listed?

YES (ADD TO TABLE)
NO

2B. Are there any other people who may not be members of your family, such as domestic servants, lodgers, or friends who usually live here?

YES (ADD TO TABLE)
NO

2C. Are there any guests or temporary visitors staying here, or anyone else who stayed here last night, who have not been listed?

YES (ADD TO TABLE)
NO

3. RELATIONSHIP TO HEAD OF HOUSEHOLD: What is the relationship of (NAME) to the head of the household?

01 HEAD
02 WIFE OR HUSBAND
03 SON OR DAUGHTER
04 SON-IN-LAW OR DAUGHTER-IN-LAW
05 GRANDCHILD
06 PARENT
07 PARENT-IN-LAW
08 BROTHER OR SISTER
09 OTHER RELATIVE
10 ADOPTED/FOSTER/STEPCHILD
11 NOT RELATED
98 DON'T KNOW

4. SEX: Is (NAME) male or female?

MALE 1
FEMALE 2

5. RESIDENCE: Does (NAME) usually live here?

YES 1
NO 2

6. Did (NAME) stay here last night?

YES 1
NO 2

7. AGE: How old is (NAME)?

IF 95 OR MORE, RECORD '95'.

IN YEARS ___

IF AGE 15 OR OLDER:

8. MARITAL STATUS: What is (NAME)'s current marital status?

1 MARRIED OR LIVING TOGETHER
2 DIVORCED/SEPARATED
3 WIDOWED
4 NEVER-MARRIED AND NEVER LIVED TOGETHER

ELIGIBILITY

9. CIRCLE LINE NUMBER OF ALL WOMEN AGE 15-49

10. CIRCLE LINE NUMBER OF ALL MEN AGE 15-59

11. CIRCLE LINE NUMBER OF ALL CHILDREN AGE 0-5

IF AGE 0-17: SURVIVORSHIP AND RESIDENCE OF BIOLOGICAL PARENTS

12. Is (NAME)'s natural mother alive?

YES 1
NO 2 (GO TO 14)
DON'T KNOW 8 (GO TO 14)

13. Does (NAME)'s natural mother usually live in this household or was she a guest last night?

IF YES: What is her name?

RECORD MOTHER'S LINE NUMBER.

IF NO, RECORD '00'.

___

14. Is (NAME)'s natural father alive?

YES 1
NO 2 (GO TO 16)
DON'T KNOW 8 (GO TO 16)

15. Does (NAME)'s natural father usually live in this household or was he a guest last night?

IF YES: What is his name?

RECORD FATHER'S LINE NUMBER.

IF NO, RECORD '00'.

___

IF AGE 5 YEARS OR OLDER: EVER ATTENDED SCHOOL

16. Has (NAME) ever attended school?

YES 1
NO 2 (GO TO NEXT LINE)

17. What is the highest level of school (NAME) has attended? What is the highest grade/number of years (NAME) completed at that level?

LEVEL
0 PRESCHOOL
1 PRIMARY
2 SECONDARY
3 TECHNICAL/VOCATIONAL
4 HIGHER
8 DON'T KNOW
GRADE
00 LESS THAN 1 YEAR COMPLETED (USE '00' FOR QUESTION 17 ONLY. THIS CODE IS NOT ALLOWED FOR QUESTION 19)
98 DON'T KNOW

IF AGE 5-24 YEARS: CURRENT/RECENT SCHOOL ATTENDANCE

18. Did (NAME) attend school at any time during the (2015-2016) school year?

YES 1
NO 2 (GO TO NEXT LINE)

19. During (this/that) school year, what level and grade (is/was) (NAME) attending?

LEVEL
0 PRESCHOOL
1 PRIMARY
2 SECONDARY
3 TECHNICAL/VOCATIONAL
4 HIGHER
8 DON'T KNOW
GRADE
00 LESS THAN 1 YEAR COMPLETED (USE '00' FOR QUESTION 17 ONLY. THIS CODE IS NOT ALLOWED FOR QUESTION 19)
98 DON'T KNOW

IF AGE 0-4 YEARS: BIRTH REGISTRATION

20. Does (NAME) have a birth certificate?

IF NO, PROBE: Has (NAME)'s birth ever been registered with the woreda or kebele?

1 HAS CERTIFICATE
2 REGISTERED
3 NEITHER
8 DON'T KNOW

HOUSEHOLD CHARACTERISTICS

101. What is the main source of drinking water for members of your household?

PIPED WATER
PIPED INTO DWELLING 11 (GO TO 106)
PIPED TO YARD/PLOT 12 (GO TO 106)
PIPED TO NEIGHBOR 13 (GO TO 106)
PUBLIC TAP/STANDPIPE 14 (GO TO 103)
TUBE WELL OR BOREHOLE 21 (GO TO 103)
DUG WELL
PROTECTED WELL 31 (GO TO 103)
UNPROTECTED WELL 32 (GO TO 103)
WATER FROM SPRING
PROTECTED SPRING 41 (GO TO 103)
UNPROTECTED SPRING 42 (GO TO 103)
RAINWATER 51 (GO TO 103)
TANKER TRUCK (BOTI) 61 (GO TO 103)
CART WITH SMALL TANK 71 (GO TO 103)
SURFACE WATER (RIVER/DAM/LAKE/POND/STREAM/CANAL/IRRIGATION CHANNEL) 81 (GO TO 103)
BOTTLED WATER 91

OTHER (SPECIFY) 96 (GO TO 103)

102. What is the main source of water used by your household for other purposes such as cooking and handwashing?

PIPED WATER
PIPED INTO DWELLING 11 (GO TO 106)
PIPED TO YARD/PLOT 12 (GO TO 106)
PIPED TO NEIGHBOR 13 (GO TO 106)
PUBLIC TAP/STANDPIPE 14
TUBE WELL OR BOREHOLE 21
DUG WELL
PROTECTED WELL 31
UNPROTECTED WELL 32
WATER FROM SPRING
PROTECTED SPRING 41
UNPROTECTED SPRING 42
RAINWATER 51
TANKER TRUCK (BOTI) 61
CART WITH SMALL TANK 71
SURFACE WATER (RIVER/DAM/LAKE/POND/STREAM/CANAL/IRRIGATION CHANNEL) 81

OTHER (SPECIFY) 96

103. Where is that water source located?

IN OWN DWELLING 1 (GO TO 105)
IN OWN YARD/PLOT 2 (GO TO 105)
ELSEWHERE 3

104. How long does it take to go there, get water, and come back?

MINUTES ___
DON'T KNOW 998

104A. Who usually goes to this source to fetch the water for your household?

ADULT WOMAN 1
ADULT 2
FEMALE CHILD UNDER 15 YEARS OLD 3
MALE CHILD UNDER 15 YEARS OLD 4
OTHER (SPECIFY) 96

105. CHECK 101 AND 102: CODE '14' OR '21' CIRCLED?

YES (GO TO 106)
NO (GO TO 107)

106. In the past two weeks, was the water from this source not available for at least one full day?

YES 1
NO 2
DON'T KNOW 8

107. Do you do anything to the water to make it safer to drink?

YES 1
NO 2 (GO TO 109)
DON'T KNOW 8 (GO TO 109)

108. What do you usually do to make the water safer to drink? Anything else?

RECORD ALL MENTIONED.

BOIL A
ADD BLEACH/CHLORINE B
STRAIN THROUGH A CLOTH C
USE WATER FILTER (CERAMIC/SAND/COMPOSITE/ETC) D
SOLAR DISINFECTION E
LET IT STAND AND SETTLE F
OTHER (SPECIFY) X
DON'T KNOW Z

109. What king of toilet facility do members of your household usually use?

IF NOT POSSIBLE TO DETERMINE, ASK PERMISSION TO OBSERVE THE FACILITY.

FLUSH OR POUR FLUSH TOILET
FLUSH TO PIPED SEWER SYSTEM 11
FLUSH TO SEPTIC TANK 12
FLUSH TO PIT LATRINE 13
FLUSH TO SOMEWHERE ELSE 14
FLUSH, DON'T KNOW WHERE 15
PIT LATRINE
VENTILATED IMPROVED IT LATRINE 21
PIT LATRINE WITH SLAB 22
PIT LATRINE WITHOUT SLAB/OPEN PIT 23
COMPOSTING TOILET 31
BUCKET TOILET 41
HANGING TOILET/HANGING LATRINE 51
NO FACILITY/BUSH/FIELD 61 (GO TO 113)
OTHER (SPECIFY) 96

110. Do you share this toilet facility with other households?

YES 1
NO 2 (GO TO 112)

111. Including your own household, how many households use this toilet facility?

NUMBER OF HOUSEHOLD IF LESS THAN 10 ___
10 OR MORE HOUSEHOLDS 95
DON'T KNOW 98

112. Where is this toilet facility located?

IN OWN DWELLING 1
IN OWN YARD/PLOT 2
ELSEWHERE 3

113. What type of fuel does your household mainly use for cooking?

ELECTRICITY 01
LPG 02
NATURAL GAS 03
BIOGAS 04
KEROSENE 05
CHARCOAL 06
WOOD 07
STRAW/SHRUBS/GRASS 08
AGRICULTURAL CROP 09
ANIMAL DUNG 10
NO FOOD COOKED IN HOUSEHOLD 95 (GO TO 116)
OTHER (SPECIFY) 96

114. Is the cooing usually done in the house, in a separate building, or outdoors?

IN THE HOUSE 1
IN A SEPARATE BUILDING 2 (GO TO 116)
OUTDOORS 3 (GO TO 116)
OTHER (SPECIFY) 6 (GO TO 116)

115. Do you have a separate room which is used as a kitchen?

YES 1
NO 2

116. How many rooms in this household are used for sleeping?

ROOMS ___

117. Does this household own any livestock, herds, other farm animals, or poultry?

YES 1
NO 2 (GO TO 119)

118. How many of the following animals does this household own?

IF NONE, RECORD '00'.

IF 95 OR MORE, RECORD '95'.

IF UNKNOWN, RECORD '98'.

a. Milk cows, oxen or bulls?
___
b. Other cattle?
___
c. Horses, donkeys, or mules?
___
d. Camels?
___
e. Goats?
___
f. Sheep?
___
g. Chickens or other poultry?
___
h. Beehives?
___

119. Does any member of this household own any agricultural land?

YES 1
NO 2 (GO TO 121)

120. How many hectares of agricultural land do members of this household own?

IF 95 ORE MORE, CIRCLE '950'.

HECTARES ___
95 OR MORE HECTARES 950
DON'T KNOW 998

121. Does your household have:

a. Electricity?
YES 1
NO 2
b. A radio?
YES 1
NO 2
c. Television?
YES 1
NO 2
d. A non-mobile telephone?
YES 1
NO 2
e. A computer?
YES 1
NO 2
f. A refrigerator?
YES 1
NO 2
g. A table?
YES 1
NO 2
h. A chair?
YES 1
NO 2
i. A bed with cotton/sponge/spring mattress?
YES 1
NO 2
j. An electric mitad?
YES 1
NO 2
k. A kerosene lamp/pressure lamp?
YES 1
NO 2

122. Does any member of this household own:

a. A watch?
YES 1
NO 2
b. A mobile phone?
YES 1
NO 2
c. A bicycle?
YES 1
NO 2
d. A motorcycle or motor scooter?
YES 1
NO 2
e. An animal-drawn cart?
YES 1
NO 2
f. A car or truck?
YES 1
NO 2
g. A boat with a motor?
YES 1
NO 2
h. A bagag?
YES 1
NO 2

123. Does any member of this household have a bank account?

YES 1
NO 2

124. How often does anyone smoke inside your house? Would you say daily, weekly, monthly, less often than once a month, or never?

DAILY 1
WEEKLY 2
MONTHLY 3
LESS OFTEN THAN ONCE A MONTH 4
NEVER 5

ADDITIONAL HOUSEHOLD CHARACTERISTICS

139. We would like to learn about the places that household use to wash their hands. Can you please show me where members of your household most often wash their hands?

OBSERVED, FIXED PLACE 1
OBSERVED, MOBILE 2
NOT OBSERVED, NOT IN DWELLING/YARD/PLOT 3 (GO TO 142)
NOT OBSERVED, NO PERMISSION TO SEE 4 (GO TO 142)
NOT OBSERVED, OTHER REASON 5 (GO TO 142)

140. OBSERVE PRESENCE OF WATER AT THE PLACE FOR HANDWASHING.

RECORD OBSERVATION.

WATER IS AVAILABLE 1
WATER IS NOT AVAILABLE 2

141. OBSERVE PRESENCE OF SOAP, DETERGENT, OR OTHER CLEANSING AGENT AT THE PLACE FOR HANDWASHING.

RECORD OBSERVATION.

SOAP OR DETERGENT (BAR, LIQUID, POWDER, PASTE) A
ASH, MUD, SAND B
NONE C

142. OBSERVE MAIN MATERIAL OF THE FLOOR OF THE DWELLING.

RECORD OBSERVATION.

NATURAL FLOOR
EARTH/SAND 11
DUNG 12
RUDIMENTARY FLOOR
WOOD PLANKS 21
PALM/BAMBOO 22
FINISHED FLOOR
PARQUET OR POLISHED WOOD 31
VINYL OR ASPHALT STRIPS/PLASTIC TILE 32
CERAMIC TILES 33
CEMENT 34
CARPET 35
OTHER (SPECIFY) 96

143. OBSERVE MAIN MATERIAL OF THE ROOD OF THE DWELLING.

RECORD OBSERVATION.

NATURAL ROOFING
NO ROOF 11
THATCH/MUD 12
SOD 13
RUDIMENTARY ROOFING
RUSTIC MAT/PLASTIC SHEET 21
REED/BAMBOO 22
WOOD PLANKS 23
CARDBOARD 24
FINISHED ROOFING
METAL/CORRUGATED IRON 31
WOOD 32
CALAMINE/CEMENT FIBER/ASBESTOS 33
CERAMIC TILES 34
CEMENT 35
ROOFING SHINGLES 36
OTHER (SPECIFY) 96

144. OBSERVE MAIN MATERIAL OF THE EXTERIOR WALLS OF THE DWELLING.

RECORD OBSERVATION.

NATURAL WALLS
NO WALLS 11
CANE/PALM/TRUNKS/BAMBOO/REED 12
DIRT 13
RUDIMENTARY WALLS
BAMBOO WITH MUD 21
STONE WITH MUD 22
UNCOVERED ADOBE 23
PLYWOOD 24
CARDBOARD 25
REUSED WOOD 26
FINISHED WALLS
CEMENT 31
STONE WITH LIME/CEMENT 32
BRICKS 33
CEMENT BLOCKS 34
COVERED ADOBE 35
WOOD PLANKS/SHINGLES 36
OTHER (SPECIFY) 96

145. I would like to check whether the salt used in your household is iodized. May I have sample of the salt used to cook meals in your household?

TEST SALT FOR IODINE.

IODINE PRESENT 1
NO IODINE 2
NO SALT IN HOUSEHOLD 3
SALT NOT TESTED (SPECIFY REASON) 6

INJURIES/ACCIDENTS

146. In the last 12 months, was nay child or adult OF YOUR HOUSEHOLD killed or injured in any incident with injuries severe enough that for at least one day they could not carry out their normal activities?

YES 1
NO 2 (GO TO NEXT SECTION)

147. What is the name of the person(s) injured or killed?

ENTER THE NAME OF EACH PERSON INJURED OR KILLED IN QUESTION 148.

IF THERE ARE MORE THAN TWO PEOPLE, USE AN ADDITIONAL QUESTIONNAIRE.

148. NAME INJURED/KILLED

NAME ___

149. Could you tell me in what type of accident (NAME) was injured or killed?

ROAD TRAFFIC ACCIDENT 01
VIOLENCE/ASSAULT 02 (GO TO 151)
FIRE/BURNING 03 (GO TO 151)
ANIMAL BITE 04 (GO TO 151)
ACCIDENTAL FALL 05 (GO TO 151)
DROWNING 06 (GO TO 151)
POISONING 07 (GO TO 151)
KICKED BY CATTLE 08 (GO TO 151)
FALL FROM TREE/BUILDING/ANIMAL BACK 09 (GO TO 151)
OTHER (SPECIFY) 96 (GO TO 151)
DON'T KNOW 98 (GO TO 151)

150. Can you tell me the type of road accident (NAME) was injured or killed?

ROAD ACCIDENT DRIVER 1
ROAD ACCIDENT OCCUPANT 2
PEDESTRIAN 3
ROAD ACCIDENT BICYCLE 4
MOTORIZED TWO WHEELER 5
OTHER (SPECIFY) 96

151. Is (NAME) still alive?

YES 1
NO 2 (GO TO 154)

152. For how long did (NAME)'s injury prevent her/him from carrying out her/his normal daily activities?

LESS THAN 7 DAYS 1
BETWEEN 8 TO 30 DAYS 2
BETWEEN 2 TO 6 MONTHS 3
LONGER THAN 6 MONTHS 4
DON'T KNOW 8

153. IF ALIVE: RECORD LINE NUMBER FROM COLUMN (1).

RECORD '00' IF PERSON NOT LISTED IN HOUSEHOLD.

LINE NUMBER ___ (GO TO NEXT COLUMN, IF NO MORE GO TO NEXT SECTION)

154. Was (NAME)'s death due to the accident?

YES 1
NO 2 (GO TO NEXT COLUMN, IF NO MORE GO TO NEXT SECTION)

155. Was (NAME) male or female?

MALE 1
FEMALE 2

156. How old was (NAME) when he/she died?

NUMBERS IN YEARS ___ (GO TO NEXT COLUMN, IF NO MORE GO TO NEXT SECTION)

TABLE FOR SELECTION OF WOMEN FOR THE DOMESTIC VIOLENCE QUESTIONS

(TO BE ADDED TO THE HOUSEHOLD QUESTIONNAIRE)

CHECK COVER PAGE OF QUESTIONNAIRE: HOUSEHOLD SELECTED FOR FEMALE GENITAL MUTILATION MODULE (FGM) AND DOMESTIC VIOLENCE

YES (CONTINUE)
NO (GO TO 157)

LOOK AT THE LAST DIGIT OF THE HOUSEHOLD QUESTIONNAIRE SERIAL NUMBER ON THE COVER PAGE. THIS IS THE ROW NUMBER YOU SHOULD GO TO. CHECK THE TOTAL NUMBER OF ELIGIBLE WOMEN (COLUMN 9) IN THE HOUSEHOLD SCHEDULE. THIS IS THE COLUMN NUMBER YOU SHOULD GO TO. FOLLOW THE SELECTED ROW AND COLUMN TO THE CELL WHERE THEY MEET AND CIRCLE THE NUMBER IN THE CELL. THIS IS THE NUMBER OF THE WOMAN SELECTED FOR THE DOMESTIC VIOLENCE QUESTIONS FROM THE LIST OF ELIGIBLE WOMEN IN COLUMN 9 OF THE HOUSEHOLD SCHEDULE. WRITE THE NAME AND LINE NUMBER OF THE SELECTED WOMAN IN THE SPACE BELOW THE TABLE.

EXAMPLE: THE HOUSEHOLD QUESTIONNAIRE SERIAL NUMBER IS '716' AND THE HOUSEHOLD SCHEDULE COLUMN 9 SHOWS THAT THERE ARE THREE ELIGIBLE WOMEN AGE 15-49 IN THE HOUSEHOLD (LINE NUMBERS 01, 04, AND 05). SINCE THE LAST DIGIT OF THE HOUSEHOLD SERIAL NUMBER IS '6' GO TO ROW '6' AND SINCE THERE ARE THREE ELIGIBLE WOMEN IN THE HOUSEHOLD, GO TO COLUMN '3'. FOLLOW THE ROW AND COLUMN AND FIND THE NUMBER IN THE CELL WHERE THEY MEET ('2') AND CIRCLE THE NUMBER. NOW GO TO THE HOUSEHOLD SCHEDULE AND FIND THE SECOND WOMAN WHO IS ELIGIBLE FOR THE WOMAN'S INTERVIEW (LINE NUMBER '04' IN THIS EXAMPLE)/ WRITE HER NAME AND LINE NUMBER IN THE SPACE BELOW THE TABLE.

LAST DIGIT OF THE HOUSEHOLD QUESTIONNAIRE SERIAL NUMBER ___
TOTAL NUMBER OF ELIGIBLE WOMEN AGE 15-49 IN HOUSEHOLD SCHEDULE COLUMN 9 ___
NAME OF SELECTED WOMAN ___
HH LINE NUMBER OF SELECTED WOMAN ___

157. RECORD THE TIME.

HOURS ___
MINUTES ___

INTERVIEWER'S OBSERVATIONS

TO BE FILLED IN AFTER COMPLETING INTERVIEW

COMMENTS ABOUT INTERVIEW:

COMMENTS ON SPECIFIC QUESTIONS:

ANY OTHER COMMENTS:

SUPERVISOR'S OBSERVATIONS

EDITOR'S OBSERVATIONS