Desi Dhaakad Nomination Form

Basic Details (All Mandatory)

* Full Name

* Email Address

* Contact Number Enter valid 10-digit mobile number

Section 1: About You (Demographics)

* 1. What is your age group?

18–25

26–35

36–45

46–55

* 2. Which state do you currently reside in?

* 3. What best describes your area of residence?

Urban (city/town)

Semi-urban

Rural

* 4. What is your highest level of education completed?

5. Which of the following best describes your household's monthly income? (Optional)

Section 2: Your Awareness of Climate Issues

Now, a few questions about your knowledge of environmental topics.

* 6. Do you know about carbon footprints?

Yes

Not well enough

Fairly well

* 7. Have you ever heard of the term "carbon footprint" (the total greenhouse gas emissions caused by your household's activities)?

Yes

Not sure

* 8. How aware are you of climate change and its effects (e.g., rising temperatures, extreme weather, impact on agriculture and health)?

1 = Not at all aware | 5 = Very aware

1 2 3 4 5

* 9. Do you believe that individual household choices (e.g., energy use, food, waste) can make a difference in reducing climate change?

* 10. How often do you take steps to save energy at home (e.g., turning off lights/fans/AC when not needed, using LED bulbs, efficient cooking)?

* 11. How often do you choose local, seasonal, or plant-based foods to reduce environmental impact?

* 12. How often do you use low-carbon transport options for short trips?

* 13. Do you currently segregate household waste at home?

Section 3: Household Energy Responsibilities

* 14. Do you personally pay your household's electricity bill?

Yes

* 15. Do you personally handle payment/refill of your household's cooking fuel?

Yes

Section 4: Your Interest in Change

* 16. How willing are you to learn and adopt simple low-carbon practices in your daily household life?

1 = Not at all willing | 5 = Very willing

1 2 3 4 5

* 17. Which of the following would help you adopt more eco-friendly choices? (Select all that apply)

Mobile app with easy carbon calculator and daily tips

Community workshops or group sessions (e.g., tied to festivals like Navratri)

Information from trusted sources (NGOs, women's groups/SHGs)

Rewards or incentives (e.g., small benefits for participation)

Easy-to-use tools like checklists or reminders

None – I already do enough / Not interested

* 18. What are the main barriers preventing you from adopting more low-carbon practices at home? (Select up to 3)

You can select maximum 3 options.

Lack of knowledge/awareness

Time constraints

Cost (e.g., energy-efficient items too expensive)

No access to tools/resources (e.g., no recycling facilities)

Family/household resistance

No perceived personal benefit

Other

* 19. Are you married?

Yes

* 20. Do you have children living in your household?

Yes

* 21. How would you feel if you were rewarded for making smart choices for the planet?

Shakti Credits 2047

Survey Form

Basic Details (All Mandatory)

Section 1: About You (Demographics)

Section 2: Your Awareness of Climate Issues

Section 3: Household Energy Responsibilities

Section 4: Your Interest in Change