Tukee Foundation

1. Personal Information

Full Name *Age *Marital Status *Date of Spouse's Death (if applicable)Cause of DeathEthnicity/CastePrimary LanguageContact NumberEducational QualificationOccupation

Do you have any chronic illness or disease? *

YesNo

If yes, specify the type of illness:

2. Address Information

Temporary AddressPermanent Address

3. Family Information

Number of ChildrenAges of Children

Are children currently attending school?

YesNo

Children in Government Schools - Sons / Daughters

Children in Private Schools - Sons / Daughters

Current Level (Government School)Current Level (Private School)

Family Type *

NuclearJointExtended

If extended family, number of elderly membersTotal Family Members

Who is the head of household?Who makes major decisions in the household?

Main Source of Family IncomeMonthly Income (Rs.)

Annual Income (Rs.)Monthly Expenses (Rs.)

Annual Expenses (Rs.)

4. Home Construction Skills & Plans

Tasks you can do yourself for home construction:

Tasks requiring external help for home construction:

Would you like to learn any construction-related skills?

YesNo

Reason for not wanting training:Do you have skilled neighbors who could help with home construction?Where and how will you source building materials?How will you arrange funds for home construction?

5. Agricultural Land & Food Security

Do you have agricultural land?

YesNo

How do you meet your food expenses?How do you cover other household expenses?

6. Social Security & Support

Do you receive government social security allowance (widow/elderly)?

YesNo

Reason for not receiving support:

7. Savings & Skills Training

Do you have savings?

YesNo

Have you ever received skill-based training?

YesNo

8. Land Ownership & Future Plans

Whose name is the land registered under?Do you own land?

If yes, specify the size/extent

What type of land is it? (Fertile/Non-fertile)Do you have any plans for remarriage?

Have you considered foreign employment/migration?

9. Additional Information

Any other information you would like to share or questions we missed?

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