Success
Record stored successfully!
AI-CAKE Form
Step 1: Basic Demographics
Full Name of Head of Family *
CNIC Number *
Phone Number *
Name of Area *
District *
Select District
Lahore
Rawalpindi
Islamabad
Other
Gender of Head of Family *
Male
Female
Age of Head of Family *
Select Age Range
18-25
26-35
36-50
51+
Marital Status *
Select Marital Status
Married
Unmarried
Divorced
Widow
Size of Household *
Size of household must be atleast 1.
House Structure *
Select House Structure
Kaccha
Pakka
Mixed
Other
Number of Rooms *
House Ownership *
Select Ownership Type
Own
Rented
Free
Other
Household Gender Distribution *
Total gender count must watch the household size.
Step 2: Education
Education of Head of Family *
Select Education Level
Below 5th Standard
Completed Primary School
Completed High School
Completed College
Bachelor’s Degree
Master’s Degree
Technical/Vocational Education
No Formal Education
Education of Other Family Members *
Other (specify):
Invalid number of family members.
No. of Children Currently Attending School *
Barriers to Education (Select all that apply)
Financial Issues
Lack of Schools Nearby
Cultural Restrictions
Child Labor
Health Issues
Other
Step 3: Employment Status
Step 4: Digital & Technological Access
Does anyone in your household own a smartphone? *
Yes
No
Does anyone use the internet regularly? *
Yes
No
Have family members used online platforms for work/study? *
Yes
No
Are you willing to learn digital skills? *
Yes
No
Step 5: Financial Inclusion & Savings
Do you have a bank/mobile banking account? *
Yes
No
Does your family save money regularly? *
Yes
No
Have you taken a loan? *
Yes
No
Loan Details
Status
Paid
Unpaid
Step 6: Social Support & Government Aid
Does your household receive government aid? *
Yes
No
If yes, which program?
Select Aid Program
BISP
ZAKAT
Social Welfare Programs
Others
Are you aware of any NGO skill programs? *
Yes
No
Please specify:
Step 7: Health & Well-being
Do you have health facilities in your area? *
Yes
No
If yes, specify the healthcare facility:
Select Available Facility
Select Facility
Hakeem
Homeopathic Doctor
Doctor
Government Dispensary
Private Dispensary
Government Hospital
Private Hospital
Other (Specify)
If no, where do you go for treatment?
Select Where Do You Go
Nearby Town
Nearby City
Tehsil Hospital
District Hospital
Other (Specify)
Have family members faced financial stress/anxiety? *
Yes
No
Is mental health support available in your area? *
Yes
No
Step 8: Nutrition & Food Security
Do you take meals three times a day? *
Yes
No
If no, how many meals per day?
How often do you eat the following (Milk, Eggs, Meat, etc.)? *
Select Frequency
Daily
Weekly
Monthly
Step 9: Sanitation & Safe Water
Do you have access to drinking water? *
Yes
No
Water Source
Select Source
Well or Boring
Hand Pump
Supply
Filtered
Other
Do you have a toilet at home? *
Yes
No
If no, what alternative is used?
Step 10: Transportation & Mobility
What is your primary mode of transportation? *
Select Transport Type
Walk
Bike
Public Transport
Private Vehicle
Other
Distance to the nearest school (km)? *
Distance to the nearest hospital (km)? *
Distance to the nearest market (km)? *
Step 11: Agriculture
Do you own any agricultural land?
Yes
No
Do you grow crops on hired land?
Yes
No
Area of land owned (in acres):
The crops you grow:
Indicator
Wheat
Rice
Sugarcane
Cotton
Other
Yield per crop per acre
Costs per crop per acre
Have you ever got an agricultural loan for farming?
Yes
No
Please specify source organization:
Amount of loan:
Duration:
Step 12: Livestock & Poultry
Do you own any livestock or poultry?
Yes
No
If yes, specify the type and numbers:
Type
Number
Hen
Sheep
Goat
Buffalo
Cow
Horse/Donkey
Other
Have you ever got a loan for poultry or livestock production?
Yes
No
Please specify source organization:
Amount of loan:
Duration:
Have you ever received information regarding poultry or livestock production through some source of communication?
Yes
No
If yes, please specify:
Sources
Please mark the option
Radio
TV
Internet
Any Other
Back
Next
Submit