Questionnaire


 
 
 

Name 


 

Address


 
 

Questions  1 - 5     Simple

Age under 7 over 100 other

Sex male female other

Telephone user yes no beep beep

Can you read ? yes no eh ?

Can you read this ? yes no mochiron !


 

Questions 6  - 10    Technical

Can you use a computer ? yes no a what ?

Do you ever use the internet ? yes no yein

Do you ever wash your hands ? yes no niemals!

Can you blow your nose ? yes no huh !

Are sticky cats sticky to stick up ? yes no tokidoki !


 

Questions 11  - 15    Profound

Have you a pink dog ? yes no maybe

Does your pinkie ever talk ? yes no secret !

Repeat the above question. yeah neah top secret !

Sex M F Y

What colour is the night ? white red other


 

Questions 16  - 19    Odd

Is 57874663 an odd number ? yes no sometimes

Is 8 an odd odd number ? yes no maybe

Is even 3 an odd even number ? yes no always

Have you answered truefully ? yes well... waka nai !


 
 
 
 
 

Any last remark.


 
 

Now for the next step.