Information of Persons with disability in Goa
Disability Rights Association of Goa (DRAG) is collecting information on persons with disability in Goa. If you are or know a person with disability in Goa please give us their details to enable us to provide better facilities for them
Name *
Your answer
Address *
Your answer
Town/Village *
Your answer
Taluka *
Your answer
State *
Your answer
Mobile/Telephone Number *
Your answer
Email
Your answer
Age *
Required
Sex *
Required
Marital Status
Type of Disability *
Required
Percentage of Disability *
Your answer
Qualification *
Required
Employment *
Required
If Employed Government or Private Sector *
Required
If Self employed Business or professional *
Required
Annual Income
Are you registered with Directorate of Social Welfare Govt. of Goa *
Required
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