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  5. Student hostage survey
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Student Bio data
 
 
 
Sex?
 
Male
 
Female
 
 
 
State and City of origin?
   
 
 
 
Marital Status?
 
Single
 
Married
 
Separated
 
Divorced
 
Widow
 
Other
 
 
 
 
School Grade?
 
First year
 
Second Year
 
Third Year
 
Fourth Year
 
Other
 
 
 
Contact Information
First Name : 
Last Name : 
Email Address : 
 
 
 
Special needs
 
 
 
Do you have special needs?
 
Yes
 
No
 
 
 
If yes, Specify.
 
Visual
 
Hearing
 
Mobility
 
Chronic Disease
 
Other, please specify
 

 
 
Where is your accommodation location?
Yes No
Inside the University Campus
Near the University Campus
Far from the University Campus
 
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