Form
Approved
OMB No. xxxx-xxxx
Exp.
Date xx/xx/20
Please complete the following information about yourself. This document is completed at the time of recruitment/interview/focus group
Individual Respondent Characteristics Survey (Staff)
Characteristic |
Response Option* |
Participant Category |
|
Sex |
|
Race |
Check all that apply:
|
Ethnicity |
|
Education Level |
|
Age |
Age (years): ___________ |
Location |
City, State: ___________________________ |
Setting Type |
|
*Each characteristic must include an option for did not respond/did not provide an answer |
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Hill, Mary A |
File Modified | 0000-00-00 |
File Created | 2023-10-06 |