Attachment 4: Demographic Questions
Attachment 4: Demographic Questions
Form Approved
OMB No. 0920-0572
Expiration Date: 06-30-2011
Demographic Questions
(Questions can be used in intercept interviews, telephone interviews, online research, and focus group screeners.)
Gender:
Male
Female
In which of the following categories does your age fall:
under 18 years of age
18-24 years of age
25-34 years of age
35-44 years of age
45-54 years of age
55-64 years of age
65-74 years of age
75 years of age or older
What is the highest level of education you have completed?
Grade school
Less than high school graduate/some high school
High school graduate or completed GED
Some college or technical school
Received four-year college degree
Some post graduate studies
Received advanced degree
Other: _____________________
Please tell me your race or ethnic background. Are you?
Ethnicity:
Hispanic or Latino
Not Hispanic or Latino
Race:
White/Caucasian
Black or African-American
American Indian or Alaska Native
Native Hawaiian or Other Pacific Islander
Asian
Vietnamese
Cambodian
Filipino
Japanese
Korean
Chinese
Other:____________________
Were you born in the United States?
Yes
No
In what state, city, and zip code do you currently live?
What is your current occupational status? Would you say…
Employed
Unemployed
Homemaker
Student
Retired, or
Disabled
Other:_______________
What is your current job title? What term would you use to describe the profession you are in?
_____________________________________________________________________
What is your marital status?
Married
Living as married
Divorced
Widowed
Separated, or
Single, never been married
Which of the following categories best describe your total, annual household income?
Under $20,000/year
$20,001 - $40,000/year
$30,001 - $60,000/year
$60,001 - $80,000/year
$80,001 - $100,000/year
Over $100,000/year
Number of children (under age 18) living in the household:
None
1-2 children
3-4 children
5 or more children
Do you currently rent or own your home?
Own
Rent
Occupied with paying monetary rent
| File Type | application/msword |
| File Title | Attachment 4: Demographic Questions |
| Author | Angela Ryan |
| Last Modified By | Angela Ryan |
| File Modified | 2008-03-17 |
| File Created | 2008-03-17 |