VATEL RWANDA APPLICATION FORM - RPL PROGRAM - HA INITIATIVE

1. RPL PROGRAM, INTAKE 1, January 2019

VATEL Rwanda Outreach!

Dear Applicants,

Thanks for applying to Vatel Rwanda! We need your input to better serve you! Answering the questions should not take long, and don't worry if you can’t understand and answer some questions or if some don’t apply to you.
If you need help filling out this form, please ask the facilitator – and we will help you.

We value your privacy, and your responses will remain confidential. Results will not be reported in any way that could identify you individually.

Thank you!

Question Title

* 1. National ID number

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* 2. Full names ( start by the family name ) and contact information

Name

Address

Country

Email Address

Phone Number

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* 3. Date of birth

Date / Time

Date

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* 4. Gender

Male

Female

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* 5. Marital status

Single

Married

Divorced

Widow

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* 6. Do you have children?

None

1-2

3-4

5-6

Above

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* 7. Are you the household head?

Yes