Cup Usage Survey 2.0 The Cova Project - Cup Usage Survey Question Title * 1. Name Question Title * 2. Age Under 18 18-24 25-34 35-44 45-54+ Question Title * 3. How long have you had your cup for? 1 month 2 months 3 months 4+ months Other (please specify) Question Title * 4. Are you using your cup? Always Most of the time Sometimes Never Other (please specify) Question Title * 5. Are you washing your cup correctly? Yes No Question Title * 6. Have you had any problems related to your cup? No Leakage Smell Problems inserting or removing Pain Infection Lost/stolen cup Other (please specify) Question Title * 7. Would you recommend the cup to others? Yes No Question Title * 8. How many days of school/work would you usually miss during your period? 0 1-2 2-4 5+ Don't attend school/work Question Title * 9. Number of days of school or work you have missed since receiving your cup? 0 1-2 2-4 5+ Don't attend school/work Question Title * 10. What is the highest level of education do you think you will achieve? Primary education Secondary Education (High school) Diploma University (degree) No schooling Other (please specify) Question Title * 11. How do you feel using your cup? Confident Nervous Judged by others In control Free Clean New opportunities Excluded from my community Other (please specify) Question Title * 12. Have you been excluded from anything because of your period since receiving your cup? Question Title * 13. Would you recommend the cup to family/friends? Yes No Why? Question Title * 14. Any additional comments that we can share with our donors? (This will help us provide more cups to more girls.) Done
