CRS: VMRC Group Information

CRS: VMRC Group Information

A: VMRC Group Information

Division Name: / XXX / Division ID: / ______/ Village Name: / YYYY / Village ID: / ______
Date of VMRC Formation: / Date this form is completed: / Time period in relation to project: / Year 1 / Year 3
______/ ______/ 20 ______/ ______/ ______/ 20 ______/ Year 2 / Year 4
day / month / year / day / month / year

B: VMRC Member Demographics

Complete ONE row for each VMRC Member.

Index
No. / VMRC Member Full Name / Gender / Age Status1 / VMRC Position2 / Community Position / Other Membership / Date left VMRC
(leave blank for baseline)
First Name / Last Name
1 / 0Male
1Female / 0 During Year 1
1 During Year 2
2During Year 3
2 / 0Male
1Female / 0 During Year 1
1 During Year 2
2During Year 3
3 / 0Male
1Female / 0 During Year 1
1 During Year 2
2During Year 3
4 / 0Male
1Female / 0 During Year 1
1 During Year 2
2During Year 3
5 / 0Male
1Female / 0 During Year 1
1 During Year 2
2During Year 3
6 / 0Male
1Female / 0 During Year 1
1 During Year 2
2During Year 3
7 / 0Male
1Female / 0 During Year 1
1 During Year 2
2During Year 3
Index
No. / VMRC Full Name / Gender / Age Status1 / VMRC Position2 / Community Position / Other Membership / Date left VMRC
(leave blank for baseline)
First Name / Last Name
8 / 0Male
1Female / 0 During Year 1
1 During Year 2
2During Year 3
9 / 0Male
1Female / 0 During Year 1
1 During Year 2
2During Year 3
10 / 0Male
1Female / 0 During Year 1
1 During Year 2
2During Year 3
11 / 0Male
1Female / 0 During Year 1
1 During Year 2
2During Year 3
12 / 0Male
1Female / 0 During Year 1
1 During Year 2
2During Year 3
13 / 0Male
1Female / 0 During Year 1
1 During Year 2
2During Year 3
14 / 0Male
1Female / 0 During Year 1
1 During Year 2
2During Year 3
15 / 0Male
1Female / 0 During Year 1
1 During Year 2
2During Year 3
Index
No. / VMRC Full Name / Gender / Age Status1 / VMRC Position2 / Community Position / Other Membership / Date left VMRC
(leave blank for baseline)
First Name / Last Name
16 / 0Male
1Female / 0 During Year 1
1 During Year 2
2During Year 3
17 / 0Male
1Female / 0 During Year 1
1 During Year 2
2During Year 3
18 / 0Male
1Female / 0 During Year 1
1 During Year 2
2During Year 3
9
19 / 0Male
1Female / 0 During Year 1
1 During Year 2
2During Year 3
20 / 0Male
1Female / 0 During Year 1
1 During Year 2
2During Year 3
21 / 0Male
1Female / 0 During Year 1
1 During Year 2
2During Year 3
22 / 0Male
1Female / 0 During Year 1
1 During Year 2
2During Year 3
23 / 0Male
1Female / 0 During Year 1
1 During Year 2
2During Year 3

1 Age Status: enter age of member at last birthday

2 VMRC Positions: General Member; Secretary; Vice President; President Page 1 of 3