STREET CHILD INFORMATION "INITIAL DATA"

General Information

REG. NO:________ Date:____________: PLACE OF INTERVIEW:_______________ ___________

01. What is your name and your nickname?

02. How old are you? What is your date of birth?........./........./.........
[ ] Less than yrs: [ ] 8 to 12 yrs
[ ] 12 to 16 yrs [ ] Above 16 yrs

03. Are you a boy or a girl? (jokingly) (please tick)
[ ] Male [ ] Female

04. What religion do you follow? (please tick)
[ ] Hindu [ ] Muslim [ ] Christian [ ] Other (specify)

05. Have you any identification marks?
a)
b)

06. How do you feel physically?
[ ] Extremely Fit [ ] Fit
[ ] Average For Age [ ] Weak [ ] Malnourished

07. Are you handicapped? (if yes, specify nature)

08. Where do you presently sleep at night?

09. How long have you been sleeping there?
[ ] Less Than One Month [ ] Less Than Six Months
[ ] 1 to 2 Years [ ] More Than 2 Years

10. Who else stays there and how many all together?
[ ] Other Boys/Girls [ ] Adults