2. Example - Situation assessment questionnaire
1.
Personal
details
1.1 Name
of individual applicant or applicant making submission on behalf of community,
group, association
1.2
Contact address
1.3
Telephone Number
Home: Work:
1.4
Fax number
1.5
Date of Birth
1.6
Identity number
2.
Demographics
2.1
If group application, provide group name
2.2
Is the group registered as a legal entity?
Yes No
If yes, please provide
details of the entity and all relevant documentation
2.3
Total number of households?
2.4
Total number of individuals in each household
2.5
Average number of individuals per household
2.6
Gender division
How many females headed households?
Number of males
Number of women
2.7
Age distribution
Under age
Schooling
Student
Working age
Pensioners
Disabled
2.8
Education levels
2.9 Skills
of applicants
ie. Farming, poultry,
weavig etc.
3.
Geographic
dispersion and preferences
3.1
Area(s) of current
residence
3.2
District and Province
3.3
Details of land identified
3.3.1
Has specific land been identified?
Yes No
I f yes, where is the land situated?
3.3.2
Provide details regarding to the land identified:
Property description
Size
Owner
Is the owner willing to sell?
Purchase
price?
If
more than one property has been identified, please provide additional
information
3.4
Details with regard to land desired
Where would you like to have land?
3.5 Briefly
describe the intended use of the land?
4.
Income &
Financial status
4.1
What is the average income of each household?
4.2
Distribution of income
R
00.00 – R 500-00
R
500.00 – R 1 000.00
R1 000.00 – R 1 500.00
R1 500.00 – R 2 000.00
4.3
Sources of income
4.4
Employers
4.5
Has the applicant received previous financial assistance
from the state?
Yes No
If yes, please provide details
4.6
Does the applicant own land?
Yes No
If yes, please provide details
5.
Current land
tenure arrangements
Farm
worker
Lease
holder
Labour tenant
Permission to occupy
Land/House
owner
Individual
title
Other (please specify)
