I. General Information

Name
Village		Home Number*
Land Mark*		Family Name*
Gram Panchayath
Hobli
Taluk
District
Mobile Number*		Others Contact Number*
Aadhar Number*

II. Personal Information

Sl. No	Name	Relation	Age	Qualification	Occupation

III. Occupation and Family Income Details

Occupation Types	Name of Occupation	Income (Rs.)
1.Main Occupation
2.Sub-Occupation
3.Others

IV. Land Holding Details

Land Type	Area (Acre)	Survey Number	Crop		Irrigation Source
			Main Crop	Sub Crop
Dry Land
Irrigated
Total

V. Crop Details

Previous Year	Crop	Season	Month of Sowing	Yield (q)
Current Year

VI. Method of Irrigation

Date	Method of Irrigation
	Drip Irrigation	Sprinkler Irrigation	Flood Irrigation

VIII. Integrated Farming System Details

IFS Components	YES	NO
Dairy
Poultry
Sheep Rearing
Fishery

IX. Animal Husbandry Details

Dairy/Poultry/Sheep Rearing/ Fishery	Breed Name	No of Animals	Other Benefit	Dairy Facilities
				YES	NO

X. Mass Media Details

Sl. No	Name of the Media	YES	NO
1	Newspaper (Agriculture related articles)
2	Television (Agriculture related programmes)
3	Radio (Agriculture related programmes)
4	Agriculture Magazine
5	Telephone (Agriculture related mobile application)

XI. Participation in Extension Activities

Sl. No	Extension Activities	YES	NO
1	Training Programmes
2	Field Visit
3	Krishi-Mela
4	Field Demonstration
5	Group Discussion
6	Agriculture Exhibition
7	Agriculture Tours
8	Others