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In the following questionnaire, I am going to ask you a variety of

questions. Some are concerned with the problems you faced and some

are general.

There are EIGHT options of every single answer. Please tick

mark only one answer for your each question.

I am simply interested in knowing your interests and perception

of your life.

Please complete all the questions carefully as possible. All your

answers in the questionnaire will be treated as confidential. May I

thank you very much for your co-operation.

SHAILA GAFFAR

PGDRP Student

Name: .

Age: Sex:

Education: . (Illiterate/ Literate)

Occupation:

Monthly Income:

Family Status: (Nuclear/Joint) .

Address: .

Rural / Urban:..

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1. How often has the availability of transportation been a problem foryou?

When this problem occurs has it been

a. Little problem b. Big problem

c. Not applicable d. Never

e. Lose than monthly f. monthly

g. Week. h. Daily

2. How often has the design and layout of your home made it difficult to

do what you want or need to do?

When this problem occurs has it been

a. Little problem b. Big problemc. Not applicable d. Never

e. Lose than monthly f. Monthly

g. Weeklyh. Daily

3. How often has the design and layout of buildings and places youuse in your community made it difficult to do what you want or

need to do?

When this problem occurs has it been

a. Little problem b.Big problem

c.Not applicable d.Never

e.Lose than monthly f.Monthly

g.Weekly h.Daily

4. How often has the natural environmenttemperature, terrain, climate

made it difficult to do what you want or need to do?

When this problem occurs has it been a

a. Little problem b. Big problem

c. Not applicable d. Never

e. Lose than monthly f. Monthly

g. Weekly h. Daily

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5. How often has the design and layout of buildings and places you use

in your at school at work made it difficult to do what you want or

need to do?

When this problem occurs has it been a

a. Little problem b. Big problemc. Not applicable d. Never

e. Lose than monthly f. Monthly

g. Weekly h. Daily

6. How often have other aspects of your surroundings lighting, noise,

crowds, etc - made it difficult to do what you want or need to do?

When this problem occurs has it been a

a. Little problem b. Big problem

c. Not applicable d. Never

e. Lose than monthly f. Monthly

g. Weekly h. Daily

7. How often has the information you wanted or ne eded not beenavailable in a format you can use or understand?

When this problem occurs has it been a

a. Little problem b. Big problemc. Not applicable d. Never

e. Lose than monthly f. Monthly

g. Weekly h. Daily

8. Howoften has the availability of the education and training you

needed been a problem for you?

When this problem occurs has it been a

a. Little problem b. Big problem

c. Not applicable d. Never

e. Lose than monthly f. Monthly

g. Weekly h. Daily

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9. How often has the availability of health care services and medical

care been a problem for you?

When this problem occurs has it been a

a. Little problem b. Big problem

c. Not applicable d. Never

e. Lose than monthly f. Monthly

g. Weekly h. Daily

10. How often has the lack of personal equip mentor special devices

been a problem for you? Examples might include hearing aids,

eyeglasses or wheelchairs?

When this problem occurs has it been a

a. Little problem b. Big problem

c. Not applicable d. Never

e. Lose than monthly f. Monthly

g. Weekly h. Daily

11. How often has the lack of computer technology been a problem for

you?

When this problem occurs has it been a

a. Little problem b. Big problemc. Not applicable d. Never

e. Lose than monthly f. Monthly

g. Weekly h. Daily

12. How often did you need someone elses help in your home and could

not get it easily?

When this problem occurs has it been a

a. Little problem b. Bigproblemc. Not applicable d. Never

e. Lose than monthly f. Monthly

g. Weekly h. Daily

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13. How often did you need someone elses help at school work and

could not get it easily?

When this problem occurs has it been a

a. Little problem b. Big problem

c. Not applicable d. Never

e. Lose than monthly f. Monthly

g. Weekly h. Daily

14. How often did you need someone elses help in your

communityand could not get it easily?

When it problem occurs has it been a

a. Little problem b. Big problemc. Not applicable d. Never

e. Lose than monthly f. Monthly

g. Weekly h. Daily

15. How often have other peoples attitude towards you been a problem

at home?

When this problem occurs has it been a

a. Little problem b. Big problem

c. Not applicable d. Never

e. Lose than monthly f. Monthly

g. Weekly h. Daily

16.How often have other peoples attitude towards you been a problem

at school or work?

When this problem occurs has it been a

a. Little problem b. Big problem

c. Not applicable d. Never

e. Lose than monthly f. Monthly

g. Weekly h. Daily

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17.How often have other peoples attitudes towards you been a problem

in the community?

When this problem occurs has it been a

a. Little problem b. Big problem

c. Not applicable d. Never

e. Lose than monthly f. Monthly

g. Weekly h. Daily

18. How often has a lack of support and encouragement from others in

your home been a problem?

When this problem occurs has it been a

a. Little problem b. Big problem

c. Not applicable d. Never

e. Lose than monthly f. Monthly

g. Weekly h. Daily

19. How often has a lack of support and encouragement from others in

.. Or won been a problem?

When this problem occurs has it been a

a. Little problem b. Big problem

c. Not applicable d. Never

e. Lose than monthly f . Monthly

g. Weekly h. Daily

20. How often has a lack of support and encouragement from others inyour community been a problem?

When this problem occurs has it been a

a. Little problem b. Big problem

c. Not applicable d. Never

e. Lose than monthly f. Monthly

g. Weekly h. Daily

21. How often did you experience prejudice or discrimination?

When this problem occurs has it been a

a. Little problem b. Big problem

c. Not applicable d. Never

e. Lose than monthly f. Monthly

g. Weekly h. Daily

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22. How often has the lack of programs and services in the community

been a problem?

When this problem occurs has it been a

a. Little problem b. Big problem

c. Not applicable d. Never

e. Lose than monthly f. Monthlyg. Weekly h. Daily

23. How often did the policies and rules of businesses and organizations

take problem for you?

When this problem occurs has it been a

a. Little problem b. Big problem

c. Not applicable d. Never

e. Lose than monthly f. Monthly

g. Weekly h. Daily

24. How often did education and employmentprograms and policies make

it difficult to do what you want or need to do?

When this problem occurs has it been a

a. Little problem b. Big problem

c. Not applicable d. Never

e. Lose than monthly f. Monthly

g. Weekly h. Daily

25. How often did government programs and policies make it difficult to

do what you want or need to do?

When this problem occurs has it been a

a. Little problem b. Big problem

c. Not applicable d. Never

e. Lose than monthly f. Monthly

g. Weekly h. Daily