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(DEEPEN)

Name (Optional):

Occupation:

Marital Status:

Gender:

Questionnaire Proper. Please read the questions on the left and answer by checking
Yes or No on the right side, and please answer the follow-up questions.

Yes No

1. Is there any existing program in the barangay where you are


involved?
What is the name of the program? _________________________

2. Is there any existing program in the barangay where you are a


beneficiary?
What is the name of the program? _________________________

3. Is the existing program being satisfactorily implemented?


4. Does your program cater your needs?
5. If yes (#3), would you recommend that it continuous to be
implemented?
If no (#3), would you recommend for another program?
What program would you recommend? _____________________

6. Is there any particular activity you would personally want to be


involved in?
What is the name of the activity? __________________________

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