Community IP-Index

1. Information about the respondent and the community

Question Title

* 1. Who are the respondent(s) to this questionnaire?

Name(s): *

Organization: *

Address 1:

Address 2:

City/Town: *

State/Province:

ZIP/Postal Code:

Country: *

Email Address: *

Phone Number:

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* 2. Do you allow us to publicly disclose that you are the respondent to this questionnaire?

Yes

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* 3. Do you allow us to make these data publicly available?

Yes

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* 4. What is the country?

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* 5. What region does the country belong to?

Africa

Asia

Central and South America and the Caribbean

The Arctic

Central and Eastern Europe

Russian Federation, Central Asia and Transcaucasia

North America

The Pacific

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* 6. What is the coverage of your assessment?

An entire indigenous people:

One village/community of one indigenous people:

Several villages/communities of one indigenous people:

One village/community inhabited by several indigenous peoples:

Several villages/communities inhabited by several indigenous peoples:

Please provide additional information, as possible

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* 7. Approximately, what is the total indigenous population covered by this assessment?

Total indigenous population covered by assessment:

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* 8. If your assessment covers specific villages/communities, what are the names(s) of these:

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* 9. What are the name(s) of the indigenous people(s)?

People 1:

People 2:

People 3:

People 4:

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