Fundación Para Niños Dominicanos Information

1. Name / Nombre____________________________________________________________________

2. Where Do They Live / Donde Vive_____________________________________________

3. Family / Familia ____________________________________________________________________

4. # of People in Family / Personas y Familia____________________________________

5. # of Children / # of Niños__________________________________________________________

6. Names / Nombre Age / Años

1. Mama: _____________________________________________________________________________

2. Papa: ______________________________________________________________________________

3. ______________________________________________________________________________________

4. ______________________________________________________________________________________

5. ______________________________________________________________________________________

6. ______________________________________________________________________________________

7. ______________________________________________________________________________________

8.______________________________________________________________________________________

9. ______________________________________________________________________________________

10. ____________________________________________________________________________________

7. School / Escuela
a. # of Children in School / # of Niños en Escuela________________________

b. # of Children Not in School / # of Niños No Escuela___________________

c. Why Not / Por Que_________________________________________________________

8. Children / Niños:
 a. Good Shoes / Bueno Zapatos_____________________________________________

b. Good Clothes / Buena Ropa______________________________________________

c. Good Hygiene /Beuena Higiene__________________________________________

9. Monthly Income for Family / Dinero Por Mes______________________________

10. Sources of Income / Trabaja Donde_________________________________________

11. Is Anyone Elderly or ill / Personas Muy Enferma___________________________

12. Do They Have:

a. Good House / Bueno Casa_______________________________________________

b. Good Roof / Bueno Techo_______________________________________________

c. Bathroom / Baño_________________________________________________________

d. Water / Agua______________________________________________________________

e. Food / Comida____________________________________________________________

13. Primary Needs of Family / Primero Problema Familia

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