SCDI Household Registry

Household Data Collection Form

This form collects information about your household so SCDI can understand your needs and plan the right support — food, education, health, water, clothing, or skills training. It takes about 10 minutes to complete.

Section A: Administrative & Identification Details

State

LGA

Community / Ward / Village

Residential Address / Landmark

Primary Phone Number *

Secondary Phone Number

Email Address

Head of Household Full Name *

Head of Household Sex

Head of Household Age

Marital Status

Section B: Household Membership & Core Data

List every household member. Tick where applicable under each column.

Member 1

Full Name

Gender (M/F)

Age

Relationship to Head

Education

Employment

Medical

Skills

Nutrition

Welfare

Section C: Detailed Indicator Checklist

Tick every statement that applies to this household.

1. Education for Children (Ages 0–17)

Dropout reason

2. Adult Empowerment (Ages 35+)

3. Youth Skills Acquisition (Ages 18–34)

4. Household Nutrition & Food Security

Meals per day

5. Welfare & Living Conditions

Water Source

Sanitation

6. Medical & Health Status

Nearest Health Centre Distance

Section D: Additional Remarks & Special Needs

Section E: Verification & Sign-off

Enumerator Name

Family Group Photo * Required

Upload a clear group photo showing all household members listed above. This photo is used to verify your household. The form cannot be submitted without it.

Important: Enter each person's full name clearly so we can verify your household when we call.

JPG, PNG, or WebP. Max 5 MB.

Your details are kept private and used only for SCDI programme planning.