Citizen Profile Form
Name
First Name
Last Name
Email
example@example.com
Gender
Male
Female
Prefer not to Say
Age
Pin Code
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Format: 0000000000.
Religion
Please Select
Hindu
Muslim
Sikh
Jain
Buddhist
Others
Category
Please Select
General
OBC
SC
ST
Caste / Tribe
Occupation
Please Select
Service
Business
Farmer
Student
Housewife
Others
Are You Voter of this State
Yes
No
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Profile Head of the Family
Name
First Name
Last Name
Age
Gender
Male
Female
Prefer not to Say
Do you have a ration card?
Yes
No
Do you have your Aadhar card?
Yes
No
Family Income (Per Month)
No. of family members
No. of children
What kind of a ration card do you have?
Antyodaya
Annapurna
PHH
Other
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Key Issues in Locality
Top 3 issues in your Locality
Status of the Issues
Resolve
Not Resolve
Take on the issues?
If Yes, Please Specify
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Assessment of the incumbent MLA
When was the last time the current MLA visited your booth?
Last 15 Days
Last 30 Days
Last 60 Days
Last 100 Days
When did you last visit the MLA office?
Last 15 Days
Last 30 Days
Last 60 Days
Last 100 Days
Any corruption charges of the Incumbent MLA?
Yes
No
Maybe
Are you following Your MLA in Social-media?
Yes
No
If Yes In which Platform?
Facebook
Instagram
Twitter
YouTube
WhatsApp
Telegram
Top 3 significant performance of the current MLA?
Top 3 expectation from the MLA?
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Assessment of the incumbent State Gov.
Performance of the Current MLA
Good
Bad
Don't Know
Any major corruption charges against the incumbent Govt?
Top 3 Significant performance of the current State Govt
Top 3 expectation from the incumbent govt?
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Assessment of the incumbent party - Local
Does the incumbent political party has any presence in your area/booth?
Yes
No
According to you who are the top 3 local popular leader in the Assembly?
Top 3 advantages of the incumbent Party?
Top 3 disadvantages of the incumbent Party?
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Assessment of the incumbent party- State
According to you who are the top 3 state level leader of the incumbent Party?
Top 3 advantages of the incumbent party?
Top 3 disadvantages of the incumbent party?
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Assessment of the Opposition Party-Local
Does the opposition political party (challenger) have any presence in yourarea/booth?
Yes
No
According to you who are the top 3 local popular leader in the Assembly-Opposition?
Top 3 political advantages of the opposition Party?
Top 3 disadvantages of the opposition Party?
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Assessment of the Opposition Party- State
According to you who are the top 3 state level leader of the incumbent Party?
Top 3 advantages of the opposition Party?
Top 3 disadvantages of the opposition Party?
Any social/religious influencer currently working in your area?
Influencer= Doctor/Social Worker/Advocate/Youtuber/Writer/RTI Activist/Ex-Journalist/YouTube/Religious leader /Businessman
Any social/religious influencer currently working in your area?
Yes
No
What are the core agendas of the influencer?
Which social media platform the influencer used?
Facebook
Instagram
Twitter
YouTube
WhatsApp
Telegram
Current Allegiance of the influencer-Political
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