MoreMiLK Recruitment Form 1 To register MYSELF as a dairy vendor in the MoreMiLK program 2 To register another dairy vendor UA Uasin Gishu NA Nakuru NY Nyandarua OT Other 1 Male 2 Female 96 Prefer not to say 1 Did not attend any school 2 Completed primary (nursery, Class 1–8) 3 Completed secondary (Form 1–4) 4 Completed University/College 5 Completed Postgraduate degree 6 Completed vocational training 98 Don't know 1 Shop/kiosk (sells milk and other products) 2 Milk bar (sells primarily milk in a fixed premise) 3 Street vendor (sells primarily milk in the street) 4 Mobile vendor (sells milk from a motorbike, bicycle or other mobile unit) 97 Other 1 Sole owner 2 Co-owner 3 Employee 97 Other (specify) 1 I know the month and year (or can estimate it) 98 Don't know 1 Yes 0 No # Karibu! Welcome to the MoreMiLK program! **Karibu sana!** Jiandikishe hapa ili ujiunge na mpango wa MoreMiLK. Ni rahisi, inachukua dakika chache tu. *(You are very welcome! Register here to join the MoreMiLK program. It is easy and only takes a few minutes.)* You have reached this page because you want to register your interest to become a participant in the program, either for yourself or on behalf of another dairy vendor. **Who can register?** This program is **only for dairy vendors who sell milk and milk products in the informal sector**: **mobile vendors, shops/kiosks, milk bars and street vendors.** **By submitting this form you agree to share your personal details with us.** They will be kept confidential and will only be accessed by the team managing the registration to the program. They will be used to contact you in due time to give you more information about the program. I have read the information above and I agree to share my personal details for registration to the MoreMiLK program. Are you filling this form to register YOURSELF in the MoreMiLK program, or to register another dairy vendor? Your details County where your dairy business operates Please specify the county. What is your name and surname? What is your age? What is your gender? What is the highest education level you have completed? What is your telephone number? Enter exactly 10 digits, e.g. 0712345678. Please type your telephone number again to confirm it. Please specify the other type of dairy business. **Thank you for your interest in the MoreMiLK program.** The program is only open to dairy vendors who sell milk and milk products in the informal sector (mobile vendors, shops/kiosks, milk bars and street vendors), so we are not able to register this business. You can press **Submit** to finish, or go back if you selected the wrong option. What is the name of your dairy business? If you operate more than one dairy business, please indicate the name of the one which you wish to sign up for the MoreMiLK program. If the business has no name, write NONE. What type of dairy business is the one you named? What is your position in the named dairy business? Please specify your position. How many co-owners share the ownership of the business? Please include yourself as an owner in the count. For example, if you share the ownership with another person, write 2. What percent of the business do you own? Enter a number between 1 and 99. If you don't know, enter 0. When did the dairy business first begin operating? Month and year the dairy business first began operating If you are not sure, give your best estimate. Vendor details Full name of person filling this form Has the dairy vendor agreed that you may share their personal details (such as their name and telephone number) with the MoreMiLK team for this registration? County where the dairy business registering in the MoreMiLK program operates Please specify the county. Name and surname of the dairy vendor applying to the MoreMiLK program What is the age of the dairy vendor? If you don't know the exact age, give your best estimate. What is the gender of the dairy vendor? What is the highest education level completed by the vendor? Telephone number of the dairy vendor registering to the MoreMiLK program Enter exactly 10 digits, e.g. 0712345678. Please type the dairy vendor's telephone number again to confirm it. Please specify the other type of dairy business. **Thank you for your interest in the MoreMiLK program.** The program is only open to dairy vendors who sell milk and milk products in the informal sector (mobile vendors, shops/kiosks, milk bars and street vendors), so we are not able to register this business. You can press **Submit** to finish, or go back if you selected the wrong option. What is the name of the dairy business? If the vendor operates more than one dairy business, please indicate the name of the one to be signed up for the MoreMiLK program. If the business has no name, write NONE. What type of dairy business is the named one? What is the vendor's position in the named dairy business? Please specify the vendor's position. How many co-owners share the ownership of the business? Please include the vendor as an owner in the count. For example, if the ownership is shared by the vendor and another person, write 2. What percent of the business does the vendor own? Enter a number between 1 and 99. If you don't know, enter 0. When did the dairy business first begin operating? Month and year the dairy business first began operating If you are not sure, give your best estimate. **Thank you for registering to the MoreMiLK program.** Please press **Submit** to send your registration. Once it has been received, we will be in touch in due time on **** to give you additional information.