NHTSA 2004 Motorcycle Jackets Survey

Assessing the Fit and Comfort of Motorcycle Safety Gear

NHTSA Form 2004_Jackets

Rider Fully Participates - Screened, Consented, Completed One Survey Type

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Assessing the Fit and Comfort of Motorcycle Safety Gear

NHTSA Form No. 2004

Paperwork Reduction Act Statement: A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with, a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a current valid OMB Control Number (listed below). Please send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: Information Collection Clearance Officer, National Highway Traffic Safety Administration, 1200 New Jersey Ave, S.E., Room W45-205, Washington, DC, 20590.


Data Collection Forms – Jackets

Note: These surveys involve skip logic. Skip logic points and survey logistics are highlighted in Boldface Red Text.

Data Collector Initial Observations

(The Data Collector will complete the following section)

Data Collector ID: ___________ (Auto fill)

  1. Potential participant gear worn (Heat Spot selection on electronic tablet form. Researcher selects observed gear by tapping on the corresponding image. Each selected gear type, indicated by a green highlighted box, will open an image library of that gear’s subtypes. Non-selected gear will be skipped.)

(Note: Green example highlighting on right is for clarification purposes only. Example highlighting shown on rightmost image will not appear in data form until after the researcher selects it.)




1a. (Complete if “Helmet” was selected as observed, otherwise skip)

The helmet is:

  • A protective motorcycle helmet (DOT label observed)

  • A protective motorcycle helmet (DOT label not visible)

  • A protective non-motorcycle helmet

  • Not protective

  • Could not determine

1b. (Complete if “Jacket” was selected as observed, otherwise skip)

The jacket is:

  • A protective motorcycle jacket

  • A protective non-motorcycle jacket

  • Not protective

  • Could not determine


1c. (Complete if “Pants” was selected as observed, otherwise skip)

The pants are:

  • Protective motorcycle pants

  • Protective non-motorcycle pants

  • Not protective

  • Could not determine


1d. (Complete if “Gloves” was selected as observed, otherwise skip)

The gloves are:

  • Protective motorcycle gloves

  • Protective non-motorcycle gloves

  • Not protective

  • Could not determine


1e. (Complete if “Footwear” was selected as observed, otherwise skip)

The footwear is:

  • Protective motorcycle footwear

  • Protective non-motorcycle footwear

  • Not protective

  • Could not determine


  1. Weather conditions (check all that apply)

  • Sunny / Clear

  • Cloudy

  • Foggy

  • Windy

  • Rainy


2a. Approximate temperature: _______ °F

3. Age

    • Under 18

    • 18-35

    • 36-55

    • 56-64

    • 65+

    • Could not determine



4. Sex

    • Female

    • Male

    • Could not determine



5. Race and/or ethnicity (select all that apply)

  • American Indian or Alaska Native

  • Asian

  • Black or African American

  • Hispanic or Latino

  • Middle Eastern or North African

  • Native Hawaiian or Pacific Islander

  • White

  • Could not determine



6. The observed rider:

    • Was not contacted

    • Learned about the study and was not interested in participating

    • Learned about the study and began consent process



Consent Process

See other forms for eligibility and consent forms





Bike Type & Riding Information

(The participant will self-report the following information)

The following questions ask about your bike and riding habits.


7. What type of bike are you riding today?

    • Standard

    • Touring

    • Cruiser

    • Sport

    • Scooter

    • Other (please specify): __________________


  1. Make / Model: ______________________________


  1. Model year: _____________________________


  1. How long have you been riding?

    • Less than 1 year

    • 1 – 5 years

    • 6 – 10 years

    • 11 – 25 years

    • 26 – 40 years

    • More than 40 years





  1. Check the appropriate box below to indicate how often you ride for each of the following reasons:


Never

A few times per season

A few times per month

A few times per week

Daily

Commuting

Leisure / Short Recreational Trips

Traveling /

Long Distance Trips

Other

(please describe):
_______________





  1. Check the appropriate box below to indicate how often you ride in each of the following scenarios:


None of my rides

Some of my rides

About half of my rides

Most of my rides

All of my rides

Solo

With a passenger on your bike

With one other bike

In a group with two to five bikes

In a group with five or more bikes




  1. Are you or have you been a member of any motorcycle organization(s)?

    • Yes

      • List up to five of the most recent organization(s) you have been a member of, if you feel comfortable doing so.

1. ________________

2. ________________

3. ________________

4. ________________

5. ________________

    • No (Skip to question 15)



  1. (This question will appear up to five times with the embedded text from Question 13)

How does being a member of [embedded text from previous answer] influence your decision to wear protective gear?

Much less likely to wear protective gear

Somewhat less likely to wear protective gear

No influence on my decision to wear protective gear

Somewhat more likely to wear protective gear

Much more likely to wear protective gear


  1. How did you learn to ride? (Check all that apply)

    • Completed a basic motorcycle training course

    • Completed an advanced motorcycle training course

    • Completed a free online motorcycle training course

    • Completed a paid online motorcycle training course

    • Watched free motorcycle training videos online (e.g., YouTube)

    • From a friend or relative

    • From someone in my riding group, club, or association

    • Other (please specify): _________________________________________________





Protective Gear

The following questions ask about any protective motorcycle gear you wear.

For the next few questions, motorcycle gear refers to specialized clothing designed for crash injury protection, weather protection, or temperature regulation while riding.


  1. Do you own/possess a motorcycle helmet?

    • Yes

    • No



16a.


None of my rides

Some of my rides

About half of my rides

Most of my rides

All of my rides

How often do you wear a motorcycle helmet?



  1. Do you own/possess a motorcycle jacket?

    • Yes

    • No



17a.


None of my rides

Some of my rides

About half of my rides

Most of my rides

All of my rides

How often do you wear a motorcycle jacket?





  1. Do you own/possess motorcycle pants?

    • Yes

    • No


18a.


None of my rides

Some of my rides

About half of my rides

Most of my rides

All of my rides

How often do you wear motorcycle pants?



  1. Do you own/possess motorcycle footwear?

    • Yes

    • No



19a.


None of my rides

Some of my rides

About half of my rides

Most of my rides

All of my rides

How often do you wear motorcycle footwear?



  1. Do you own/possess motorcycle gloves?

    • Yes

    • No



20a.


None of my rides

Some of my rides

About half of my rides

Most of my rides

All of my rides

How often do you wear motorcycle gloves?

  1. How does wearing a motorcycle jacket affect each of the following for you? (Items will be randomized)


Significantly decreases

Somewhat decreases

No change

Somewhat increases

Significantly increases

Riding comfort

Arm movement

Ability to mount & dismount bike

Ability to operate the bike











(Question will be displayed to the participant if they answered “Yes” to Question 17)

  1. Indicate how much you agree/disagree with the following statements regarding your motorcycle jacket. (Items will be randomized)

My jacket (is):


Strongly disagree

Somewhat disagree

Neutral

Somewhat agree

Strongly agree

Comfortable

Allows for breathability / air flow

Stays in position while riding

Protective

Well designed for my body

Easy to put on

Easy to take off

Provides adequate range of motion

Fits snug around torso

  1. Indicate how the following factors influence your motorcycle jacket usage. (Items will be randomized)


Influences to wear LESS

No influence

Influences to

Wear MORE

Increased risk of injury and fatality

Friends who I ride with

My riding community

Social media

News coverage about motorcycle safety

Family/loved one’s concerns

High cost of motorcycle jackets

Personal near miss/close call

Witnessing a crash

Learning about injuries among riders not wearing a motorcycle jacket

Advice from a motorcycle professional

Advice from a medical professional

Other (please specify):

_________________






  1. How important is the fit of a motorcycle jacket to you?

Extremely unimportant

Somewhat unimportant

Neutral

Somewhat important

Extremely important



  1. How important is the comfort of a motorcycle jacket to you?

Extremely unimportant

Somewhat unimportant

Neutral

Somewhat important

Extremely important



  1. How important is having a highly protective motorcycle jacket to you?

Extremely unimportant

Somewhat unimportant

Neutral

Somewhat important

Extremely important



  1. What are the top three things you consider when purchasing a motorcycle jacket?

    • 1. ________________________

    • 2. ________________________

    • 3. ________________________



Anthropometric Measurements for Motorcycle Jacket

(Data Collector will ask participant the following questions and record the answers)


  1. (Data collector asks) Height: ___________ feet and inches (self-reported)


  1. (Data collector measures) Sleeve length: ____________ centimeters


  1. (Data collector measures) Chest/bust circumference: __________________ centimeters


  1. (Data collector measures) Waist: ___________________ centimeters


  1. (Data collector measures) Hips: ___________________ centimeters



  1. (Data collector observes) Did the participant wear a motorcycle jacket to the event?

    • Yes (Continue to Question 34)

    • No (Skip to Question 51)



Jacketed Rider Questions


  1. (Data collector asks) Is this your usual motorcycle jacket?

    • Yes

    • No



  1. (Data collector asks) How did you obtain this jacket?

    • Bought new in-store, tried on

    • Bought new in-store, did not try on

    • Bought new online

    • Bought used online

    • Bought new from a friend

    • Bought used from a friend

    • Bought used in-store, tried on

    • Bought used in-store, did not try on

    • Borrowed from a friend

    • Received as a gift

    • Other (please specify): _________________________



  1. (Data collector asks) Did someone help fit you for this jacket?

    • Yes (please specify): ________________

    • No



  1. (Data collector observes) Jacket type:

  • Mesh

  • Textile

  • Leather

  • Armored

  • Combination

  • Part of one-piece riding suit

  • Other (please specify): __________________________

  • Unknown





  1. (Data collector observes) Primary / Most prominent color(s) (check all that apply):

    • Black

    • White

    • Brown

    • Red

    • Orange

    • Yellow / Neon

    • Green

    • Blue

    • Purple

    • Pink

    • Tan

    • Silver / Grey

    • Mixed / Graphic

    • Other (please specify): ________________



  1. (Data collector observes) Jacket manufacturer:

  • Alpinestars

  • BILT

  • Dainese

  • Fly Racing

  • Icon Contra

  • Klim

  • Merlin Axe

  • REV’IT

  • Scorpion

  • Sedici

  • Street & Steel

  • Other (please specify) : __________

  • Unknown



  1. (Data collector observes) Size: ______________________________

    • Could not determine


  1. (Data collector observes) Safety labels (check all that apply):

    • DOT (meets or exceeds DOT FMVSS 218)

    • ECE

    • CE

    • AAA

    • Other (please specify): _________________

    • None present




  1. (Data collector asks) Have you made any modifications to this jacket? (Check all that apply)

    • Airbag vest:

      • Makes less protective

      • No change in protection

      • Makes more protective

      • Could not determine

    • Armor modified:

      • Makes less protective

      • No change in protection

      • Makes more protective

      • Could not determine

    • Added cosmetic accessories (list all): _________

      • Makes less protective

      • No change in protection

      • Makes more protective

      • Could not determine

    • Added “safety” accessories (list all): ________

      • Makes less protective

      • No change in protection

      • Makes more protective

      • Could not determine

  • None present



  1. (Data collector asks) Have you added any retroreflective features to this jacket?

    • Yes, after-market / accessory added after purchase

    • No, accessory OEM / factory installed

    • No, none present





Motorcycle Jacket Fit Assessment

(Data collector reads the following to the participant) “I’m going make some observations to see how well your motorcycle jacket fits. (If not already wearing their jacket) Please put your motorcycle jacket on as you normally would when riding. (If applicable) Please also put on your motorcycle gloves as you normally would. As best you can, please simulate the riding position you would normally take while riding your own bike.”


  1. (Data collector observes) Are there fasteners, buckles, Velcro, or straps to adjust fit present on this jacket?

    • Yes

    • No



  1. (Data collector observes) Do the jacket sleeves fully cover the wrist to the motorcycle gloves (if gloves present), or do the jacket sleeves fully cover the wrist (if no gloves present) when the participant is seated in the simulated riding position?

  • Yes

  • No



  1. (Data collector observes) Does this jacket cover the belt line?

    • Yes

    • No



  1. (Data collector asks) Does this jacket have armor? If so, what types of armor?

  • Chest

  • Elbow

  • Forearm

  • Shoulder

  • Spine

  • Other (please specify): ___________________

  • No armor (Skip to Question 49)



48a. (Complete if “Chest” was selected in Question 47, otherwise skip)

(Data collector reads the following to the participant) “While maintaining one arm in the proper riding position, please point to the location of your chest armor.” (Data collector observes) Is the participant’s chest armor correctly positioned when the participant is in the simulated riding position?

    • Yes

    • No





48b. (Complete if “Elbow” was selected in Question 47, otherwise skip)

(Data collector reads the following to the participant) “While maintaining one arm in the proper riding position, please point to the location of your elbow armor.” (Data collector observes) Is the participant’s elbow armor correctly positioned when the participant is in the simulated riding position?

    • Yes

    • No


48c. (Complete if “Forearm” was selected in Question 47, otherwise skip)

(Data collector reads the following to the participant) “While maintaining one arm in the proper riding position, please point to the location of your forearm armor.” (Data collector observes) Is the participant’s forearm armor correctly positioned when the participant is in the simulated riding position?

    • Yes

    • No


48d. (Complete if “Shoulder” was selected in Question 47, otherwise skip)

(Data collector reads the following to the participant) “While maintaining one arm in the proper riding position, please point to the location of your shoulder armor.” (Data collector observes) Is the participant’s shoulder armor correctly positioned when the participant is in the simulated riding position?

    • Yes

    • No



48e. (Complete if “Spine” was selected in Question 47, otherwise skip)

(Data collector reads the following to the participant) “While maintaining one arm in the proper riding position, please point to the location of your spine armor.” (Data collector observes) Is the participant’s spine armor correctly positioned when the participant is in the simulated riding position?

    • Yes

    • No



  1. (Data collector observes) Does this jacket have a snug fit in the torso and arms?

    • Yes

    • No









  1. (Data collector asks) When wearing this jacket for 30 minutes or longer, do you begin to experience pain or discomfort in any of the following areas? If so, please point to those areas now. (Data collector observes areas the participant points to and selects corresponding area on the image below, and checks all that apply)

    • Bicep(s)

    • Chest

    • Elbow(s)

    • Forearm(s)

    • Lower back

    • Mid back

    • Neck

    • Shoulder(s)

    • Stomach

    • Tricep(s)

    • Upper back

    • Wrist(s)

    • Other (please specify):__________________

    • None




New Gear Assessment

(The participant will complete the following section)

In this section, you will be asked for your opinions about different types of jackets. There is a picture and description of each item to help you evaluate it. For each item, assume the jacket fits, it would come in the color you want and at an affordable cost.

(Note: Order of jackets will be randomized for each participant. The questions below will be shown with each gear choice.)


  1. Please select the type of gear you typically wear. If unsure, please select the type of gear you are currently wearing.

  • Women’s (Go to Question 52)

  • Men’s (Go to Question 58)

  • Unisex (Go to Question 58)


If “Women’s” was selected for Question 51




Extremely unprotective

Somewhat unprotective

Neutral

Somewhat protective

Extremely protective

How protective do you think this jacket is?



Extremely unlikely

Somewhat unlikely

Neutral

Somewhat likely

Extremely
likely

How likely would you be to wear this jacket while riding?



Extremely unlikely

Somewhat unlikely

Neutral

Somewhat likely

Extremely
likely

How likely would you be to purchase this jacket?



Extremely poorly

Somewhat poorly

Neutral

Somewhat well

Extremely
well

How well do you think you would be able to maintain your range of motion for riding with this jacket?



Extremely low

quality

Low

quality

Neutral

High

quality


Extremely
high

quality

What is the overall quality of this jacket?











Extremely unprotective

Somewhat unprotective

Neutral

Somewhat protective

Extremely protective

How protective do you think this jacket is?



Extremely unlikely

Somewhat unlikely

Neutral

Somewhat likely

Extremely
likely

How likely would you be to wear this jacket while riding?



Extremely unlikely

Somewhat unlikely

Neutral

Somewhat likely

Extremely
likely

How likely would you be to purchase this jacket?



Extremely poorly

Somewhat poorly

Neutral

Somewhat well

Extremely
well

How well do you think you would be able to maintain your range of motion for riding with this jacket?



Extremely low

quality

Low

quality

Neutral

High

quality

Extremely
high

quality

What is the overall quality of this jacket?










Extremely unprotective

Somewhat unprotective

Neutral

Somewhat protective

Extremely protective

How protective do you think this jacket is?



Extremely unlikely

Somewhat unlikely

Neutral

Somewhat likely

Extremely
likely

How likely would you be to wear this jacket while riding?



Extremely unlikely

Somewhat unlikely

Neutral

Somewhat likely

Extremely
likely

How likely would you be to purchase this jacket?



Extremely poorly

Somewhat poorly

Neutral

Somewhat well

Extremely
well

How well do you think you would be able to maintain your range of motion for riding with this jacket?



Extremely low

quality

Low

quality

Neutral

High

quality

Extremely
high

quality

What is the overall quality of this jacket?










Extremely unprotective

Somewhat unprotective

Neutral

Somewhat protective

Extremely protective

How protective do you think this jacket is?



Extremely unlikely

Somewhat unlikely

Neutral

Somewhat likely

Extremely
likely

How likely would you be to wear this jacket while riding?



Extremely unlikely

Somewhat unlikely

Neutral

Somewhat likely

Extremely
likely

How likely would you be to purchase this jacket?



Extremely poorly

Somewhat poorly

Neutral

Somewhat well

Extremely
well

How well do you think you would be able to maintain your range of motion for riding with this jacket?



Extremely low

quality

Low

quality

Neutral

High

quality

Extremely
high

quality

What is the overall quality of this jacket?








Extremely unprotective

Somewhat unprotective

Neutral

Somewhat protective

Extremely protective

How protective do you think this jacket is?



Extremely unlikely

Somewhat unlikely

Neutral

Somewhat likely

Extremely
likely

How likely would you be to wear this jacket while riding?



Extremely unlikely

Somewhat unlikely

Neutral

Somewhat likely

Extremely
likely

How likely would you be to purchase this jacket?



Extremely poorly

Somewhat poorly

Neutral

Somewhat well

Extremely
well

How well do you think you would be able to maintain your range of motion for riding with this jacket?



Extremely low

quality

Low

quality

Neutral

High

quality

Extremely
high

quality

What is the overall quality of this jacket?











Extremely unprotective

Somewhat unprotective

Neutral

Somewhat protective

Extremely protective

How protective do you think this jacket is?



Extremely unlikely

Somewhat unlikely

Neutral

Somewhat likely

Extremely
likely

How likely would you be to wear this jacket while riding?



Extremely unlikely

Somewhat unlikely

Neutral

Somewhat likely

Extremely
likely

How likely would you be to purchase this jacket?



Extremely poorly

Somewhat poorly

Neutral

Somewhat well

Extremely
well

How well do you think you would be able to maintain your range of motion for riding with this jacket?



Extremely low

quality

Low

quality

Neutral

High

quality

Extremely
high

quality

What is the overall quality of this jacket?



If “Men’s” was selected for Question 51












Extremely unprotective

Somewhat unprotective

Neutral

Somewhat protective

Extremely protective

How protective do you think this jacket is?



Extremely unlikely

Somewhat unlikely

Neutral

Somewhat likely

Extremely
likely

How likely would you be to wear this jacket while riding?



Extremely unlikely

Somewhat unlikely

Neutral

Somewhat likely

Extremely
likely

How likely would you be to purchase this jacket?



Extremely poorly

Somewhat poorly

Neutral

Somewhat well

Extremely
well

How well do you think you would be able to maintain your range of motion for riding with this jacket?



Extremely low

quality

Low

quality

Neutral

High

quality

Extremely
high

quality

What is the overall quality of this jacket?










Extremely unprotective

Somewhat unprotective

Neutral

Somewhat protective

Extremely protective

How protective do you think this jacket is?



Extremely unlikely

Somewhat unlikely

Neutral

Somewhat likely

Extremely
likely

How likely would you be to wear this jacket while riding?



Extremely unlikely

Somewhat unlikely

Neutral

Somewhat likely

Extremely
likely

How likely would you be to purchase this jacket?



Extremely poorly

Somewhat poorly

Neutral

Somewhat well

Extremely
well

How well do you think you would be able to maintain your range of motion for riding with this jacket?



Extremely low

quality

Low

quality

Neutral

High

quality

Extremely
high

quality

What is the overall quality of this jacket?






Extremely unprotective

Somewhat unprotective

Neutral

Somewhat protective

Extremely protective

How protective do you think this jacket is?



Extremely unlikely

Somewhat unlikely

Neutral

Somewhat likely

Extremely
likely

How likely would you be to wear this jacket while riding?



Extremely unlikely

Somewhat unlikely

Neutral

Somewhat likely

Extremely
likely

How likely would you be to purchase this jacket?



Extremely poorly

Somewhat poorly

Neutral

Somewhat well

Extremely
well

How well do you think you would be able to maintain your range of motion for riding with this jacket?



Extremely low

quality

Low

quality

Neutral

High

quality

Extremely
high

quality

What is the overall quality of this jacket?






Extremely unprotective

Somewhat unprotective

Neutral

Somewhat protective

Extremely protective

How protective do you think this jacket is?



Extremely unlikely

Somewhat unlikely

Neutral

Somewhat likely

Extremely
likely

How likely would you be to wear this jacket while riding?



Extremely unlikely

Somewhat unlikely

Neutral

Somewhat likely

Extremely
likely

How likely would you be to purchase this jacket?



Extremely poorly

Somewhat poorly

Neutral

Somewhat well

Extremely
well

How well do you think you would be able to maintain your range of motion for riding with this jacket?



Extremely low

quality

Low

quality

Neutral

High

quality

Extremely
high

quality

What is the overall quality of this jacket?






Extremely unprotective

Somewhat unprotective

Neutral

Somewhat protective

Extremely protective

How protective do you think this jacket is?



Extremely unlikely

Somewhat unlikely

Neutral

Somewhat likely

Extremely
likely

How likely would you be to wear this jacket while riding?



Extremely unlikely

Somewhat unlikely

Neutral

Somewhat likely

Extremely
likely

How likely would you be to purchase this jacket?



Extremely poorly

Somewhat poorly

Neutral

Somewhat well

Extremely
well

How well do you think you would be able to maintain your range of motion for riding with this jacket?



Extremely low

quality

Low

quality

Neutral

High

quality

Extremely
high

quality

What is the overall quality of this jacket?






Extremely unprotective

Somewhat unprotective

Neutral

Somewhat protective

Extremely protective

How protective do you think this jacket is?



Extremely unlikely

Somewhat unlikely

Neutral

Somewhat likely

Extremely
likely

How likely would you be to wear this jacket while riding?



Extremely unlikely

Somewhat unlikely

Neutral

Somewhat likely

Extremely
likely

How likely would you be to purchase this jacket?



Extremely poorly

Somewhat poorly

Neutral

Somewhat well

Extremely
well

How well do you think you would be able to maintain your range of motion for riding with this jacket?



Extremely low

quality

Low

quality

Neutral

High

quality

Extremely
high

quality

What is the overall quality of this jacket?

Demographics

(The participant will self-report the following information)

  1. In what State do you currently live? _______________________________________



  1. Which license type(s) do you currently have? (Check all that apply)

    • Motorcycle endorsement

    • Motorcycle-only license

    • Motorcycle learner’s permit

    • Driver’s license

    • Commercial license

    • None of the above



  1. What is your age? _______________ years



  1. What is your sex?

    • Female

    • Male



  1. What is your race and/or ethnicity? (Select all that apply and enter additional details in the spaces below)

  • American Indian or Alaska Native

(If selected) Provide details below:


Enter, for example, Navajo Nation, Blackfeet Tribe of the Blackfeet Indian Reservation of Montana, Native Village of Inupiat Traditional Government, Nome Eskimo Community, Aztec, Maya, etc.:

_____________________________________________________________________

  • Asian

(If selected) Provide details below:

    • Chinese

    • Asian Indian

    • Filipino

    • Vietnamese

    • Korean

    • Japanese

    • Another group (For example, Pakistani, Hmong, Afghan, etc.):

__________________________________________________________________






  • Black or African American

(If selected) Provide details below:

    • African American

    • Jamaican

    • Haitian

    • Nigerian

    • Ethiopian

    • Somali

    • Another group (For example, Trinidadian and Tobagonian, Ghanian, Congolese, etc.): ________________________________________________________________

  • Hispanic or Latino

(If selected) Provide details below:

    • Mexican

    • Puerto Rican

    • Salvadoran

    • Cuban

    • Dominican

    • Guatemalan

    • Another group (For example, Colombian, Honduran, Spaniard, etc.): __________________________________________________________________

  • Middle Eastern or North African

(If selected) Provide details below:

    • Lebanese

    • Iranian

    • Egyptian

    • Syrian

    • Iraqi

    • Israeli

    • Another group (For example, Moroccan, Yemeni, Kurdish, etc.):

________________________________________________________________

  • Native Hawaiian or Pacific Islander

(If selected) Provide details below:

    • Native Hawaiian

    • Samoan

    • Chamorro

    • Tongan

    • Fijian

    • Marshallese

    • Another group (For example, Chuukese, Palauan, Tahitian, etc.):

__________________________________________________________________






  • White

(If selected) Provide details below:

    • English

    • German

    • Irish

    • Italian

    • Polish

    • Scottish

    • Another group (For example, French, Swedish, Norwegian, etc.):

_________________________________________________________________









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