Various Demographic Area Pretesting Activities

Participant #________________

Demographic Information

1. In what month and year were you born? _________________ __________________

month year

2. What is the highest grade or year of school you have completed?

G Less than high school

G Completed high school

G Some college, no degree (indicate area of study: ____________________________________)

G Associate’s degree (AA/AS) (indicate area of study: __________________________________)

G Bachelor’s Degree (BA/BS) (indicate area of study: __________________________________)

G Post-Bach degree (indicate degree and area of study: ________________________________)

3. Are you male or female?

G Male

G Female

4. Are you of Hispanic, Latino, or Spanish origin?

G Yes

G No

5. What is your race? Choose one or more races.

G White

G Black or African American

G American Indian or Alaska Native

G Asian

G Native Hawaiian or Other Pacific Islander