OMB Control No. 0690-0030
Expiration Date: 6/30/17
Focus Group Worksheet
Your
response to these questions is voluntary.
In what year were you born? __________________ year
What is the highest grade or year of school you have completed?
Less than high school
Completed high school
Some college, no degree
Associate’s degree (AA/AS)
Bachelor’s degree (BA/BS)
Post-bachelor’s degree (for example, MA, MS, PhD, MD)
Are you male or female?
Male
Female
Are you of Hispanic, Latino, or Spanish origin?
Yes
No
What is your race? Choose one or more races.
White
Black or African American
American Indian or Alaska Native
Asian
Native Hawaiian or Other Pacific Islander
How many people age 16 or older currently live in your household, INCLUDING yourself?
_________
How many people younger than age 16 currently live in your household?
_________
Do you currently live with all family members, some family members and some non-family members, or all non-family members?
All family members
Some family members and some non-family members
All non-family members
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Jessica Holzberg (CENSUS/CSM FED) |
File Modified | 0000-00-00 |
File Created | 2021-01-22 |