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Million Mentors
Program Evaluation
Partners Worldwide - Million Mentors Program
Survey Questionnaire
For Business Owners/Entrepreneurs
Section A: General Information and Background
1. What is your name?
Enter
[none]
for no response
2. What is your age?
years
Enter 999 for no response
3. What is your marital status?
Single
Married
Divorced
Widowed
no response
Please choose one
4. How many children are in your family?
Enter 999 for no response
5. How many others are dependent on you?
Enter 999 for no response
6. How many years of formal education have you had?
Enter 999 for no response
7. What is your religious affiliation?
Enter
[none]
for no response
8. What is your average annual family income?
Below $1000
$1000-$3000
$3000-$6000
$6000-$12000
Above $12000
no response
9. How many years have you worked in business or farming?
years
Enter 999 for no response
10. If your current primary business has a name, what is it?
Enter
[none]
for no response
11A. Did you start this business yourself?
Yes
You will go to 12
No
You will go to 11B
no response
11B. If no, please explain:
Enter
[none]
for no response
Optional Interviewer Comments:
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