NHTSA 2005 Motorcycle Pants Survey

Assessing the Fit and Comfort of Motorcycle Safety Gear

NHTSA Form No. 2005

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.

Table of Content

s

Data Collection Forms – Pants 2

Data Collector Initial Observations 2

Consent Process 4

Bike Type & Riding Information 5

Anthropometric Measurements for Motorcycle Pants 13

Motorcycle Pants Fit Assessment 17

New Gear Assessment 19

Demographics 43

Data Collection Forms – Pants

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

2. 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): __________________

8. Make / Model: ______________________________

8. Model year: _____________________________

8. 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

8. 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): _______________	□	□	□	□	□

8. 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	□	□	□	□	□

8. 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)

8. (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
□	□	□	□	□

8. 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.

8. 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?	□	□	□	□	□

8. 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?	□	□	□	□	□

8. 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?	□	□	□	□	□

8. 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?	□	□	□	□	□

8. 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?	□	□	□	□	□

8. How does wearing motorcycle pants affect each of the following for you? (Items will be randomized)

	Significantly decreases	Somewhat decreases	No change	Somewhat increases	Significantly increases
Riding comfort	□	□	□	□	□
Leg movement	□	□	□	□	□
Ability to mount and dismount bike	□	□	□	□	□

(Question will be displayed to the participant if they answered “Yes” to Question 18)

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

My pants (are):

	Strongly disagree	Somewhat disagree	Neutral	Somewhat agree	Strongly agree
Comfortable	□	□	□	□	□
Allow for breathability/air flow	□	□	□	□	□
Stay in position while riding	□	□	□	□	□
Protective	□	□	□	□	□
Well designed for my body	□	□	□	□	□
Easy to put on	□	□	□	□	□
Easy to take off	□	□	□	□	□
Allow my legs to bend without difficulty	□	□	□	□	□
Provide adequate range of motion	□	□	□	□	□
Fit snug around the waist	□	□	□	□	□

8. Indicate how the following factors influence your motorcycle pants 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 pants	□	□	□
Personal near miss/close call	□	□	□
Witnessing a crash	□	□	□
Learning about injuries among riders not wearing motorcycle pants	□	□	□
Advice from a motorcycle professional	□	□	□
Advice from a medical professional	□	□	□
Other (please specify): _________________	□	□	□

8. How important is the fit of motorcycle pants to you?

Extremely unimportant	Somewhat unimportant	Neutral	Somewhat important	Extremely important
□	□	□	□	□

8. How important is the comfort of motorcycle pants to you?

Extremely unimportant	Somewhat unimportant	Neutral	Somewhat important	Extremely important
□	□	□	□	□

8. How important is having a highly protective pair of motorcycle pants to you?

Extremely unimportant	Somewhat unimportant	Neutral	Somewhat important	Extremely important
□	□	□	□	□

8. What are the top three things you consider when purchasing motorcycle pants?

• 1. ________________________

• 2. ________________________

• 3. ________________________

Anthropometric Measurements for Motorcycle Pants

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

8. (Data collector observes) Waist: __________ centimeters

8. (Data collector measures) Hips: __________ centimeters

8. (Data collector measures) Inseam length: ________ centimeters

8. (Data collector observes) Did the participant wear motorcycle pants to the event?

• Yes (Continue to Question 32)

• No (Skip to Question 48)

Pants Wearing Rider Questions

8. (Data collector asks) Are these your usual motorcycle pants?

• Yes

• No

8. (Data collector asks) How did you obtain these pants?

• 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): _________________________

8. (Data collector asks) Did someone help fit you for these pants?

• Yes (please specify): ________________

• No

8. (Data collector observes) Pants type:

• Riding jeans (built in knee protection & Kevlar shorts)

• Textile

• Leather

• Mesh textile

• Overpants

• Other (please specify): __________________________

• Unknown

8. (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): ________________

8. (Data collector observes) Pants manufacturer:

• Alpinestars

• BILT

• Dainese

• Fly Racing

• Highway 21

• Iron Workers

• Klim

• REAX

• REV’IT

• Scorpion

• Sedici

• Street & Steel

• Other (please specify): __________

• Unknown

8. (Data collector observes) Model: ____________________________

• Could not determine

8. (Data collector observes) Size: ______________________________

• Could not determine

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

• DOT (meets or exceeds DOT FMVSS 218)

• ECE

• CE

• AAA

• Other (please specify): _________________

• None present

8. (Data collector asks) Have you made any modifications to these pants? (Check all that apply)

• Knee braces:

  • 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 (please list):

  • Makes less protective

  • No change in protection

  • Makes more protective

  • Could not determine

• Added “safety” accessories (please list):

  • Makes less protective

  • No change in protection

  • Makes more protective

  • Could not determine

• None present

8. (Data collector asks) Have you added any retroreflective features to these pants?

• Yes, after-market / accessory added after purchase

• No, accessory OEM / factory installed

• No, none present

Motorcycle Pants Fit Assessment

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

8. (Data collector observes) Are there fasteners, buckles, Velcro, or straps to adjust fit present on these pants?

• Yes

• No

8. (Data collector observes) Do the pant legs cover the ankle or top of the footwear?

• Yes

• No

8. (Data collector asks) Do these pants have armor? If so, what types of armor?

• Hips

• Knees

• Shins

• Tailbone

• Thighs

• Other (please specify): ___________________

• No armor (Skip to Question 47)

46a. (Complete if “Hips” was selected in Question 45, 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 hip armor.” (Data collector observes) Is the participant’s hip armor correctly positioned when the participant is in the simulated riding position?

• Yes

• No

46b. (Complete if “Knees” was selected in Question 45, 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 knee armor.” (Data collector observes) Is the participant’s knee armor correctly positioned when the participant is in the simulated riding position?

• Yes

• No

46c. (Complete if “Shins” was selected in Question 45, 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 shin armor.” (Data collector observes) Is the participant’s shin armor correctly positioned when the participant is in the simulated riding position?

• Yes

• No

46d. (Complete if “Tailbone” was selected in Question 45, 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 tailbone armor.” (Data collector observes) Is the participant’s tailbone armor correctly positioned when the participant is in the simulated riding position?

• Yes

• No

46e. (Complete if “Thighs” was selected in Question 45, 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 thigh armor.” (Data collector observes) Is the participant’s thigh armor correctly positioned when the participant is in the simulated riding position?

• Yes

• No

47. (Data collector asks) When wearing these pants 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)

• Ankle(s)

• Buttock(s)

• Calf/calves

• Groin

• Hamstring(s)

• Hip(s)

• Quadricep(s)

• Shin(s)

• Tailbone

• 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 pants. There is a picture and description of each item to help you evaluate it. For each item, assume the pants fit, it would come in the color you want and at an affordable cost.

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

47. 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 49)

• Men’s (Go to Question 55)

• Unisex (Go to Question 55)

If “Women’s” was selected for Question 48

	Extremely unprotective	Somewhat unprotective	Neutral	Somewhat protective	Extremely protective
How protective do you think these pants are?	□	□	□	□	□

	Extremely unlikely	Somewhat unlikely	Neutral	Somewhat likely	Extremely likely
How likely would you be to wear these pants while riding?	□	□	□	□	□

	Extremely unlikely	Somewhat unlikely	Neutral	Somewhat likely	Extremely likely
How likely would you be to purchase these pants?	□	□	□	□	□

	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 these pants?	□	□	□	□	□

	Extremely low quality	Low quality	Neutral	High quality	Extremely high quality
What is the overall quality of these pants?	□	□	□	□	□

	Extremely unprotective	Somewhat unprotective	Neutral	Somewhat protective	Extremely protective
How protective do you think these pants are?	□	□	□	□	□

	Extremely unlikely	Somewhat unlikely	Neutral	Somewhat likely	Extremely likely
How likely would you be to wear these pants while riding?	□	□	□	□	□

	Extremely unlikely	Somewhat unlikely	Neutral	Somewhat likely	Extremely likely
How likely would you be to purchase these pants?	□	□	□	□	□

	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 these pants?	□	□	□	□	□

	Extremely low quality	Low quality	Neutral	High quality	Extremely high quality
What is the overall quality of these pants?	□	□	□	□	□

	Extremely unprotective	Somewhat unprotective	Neutral	Somewhat protective	Extremely protective
How protective do you think these pants are?	□	□	□	□	□

	Extremely unlikely	Somewhat unlikely	Neutral	Somewhat likely	Extremely likely
How likely would you be to wear these pants while riding?	□	□	□	□	□

	Extremely unlikely	Somewhat unlikely	Neutral	Somewhat likely	Extremely likely
How likely would you be to purchase these pants?	□	□	□	□	□

	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 these pants?	□	□	□	□	□

	Extremely low quality	Low quality	Neutral	High quality	Extremely high quality
What is the overall quality of these pants?	□	□	□	□	□

	Extremely unprotective	Somewhat unprotective	Neutral	Somewhat protective	Extremely protective
How protective do you think these pants are?	□	□	□	□	□

	Extremely unlikely	Somewhat unlikely	Neutral	Somewhat likely	Extremely likely
How likely would you be to wear these pants while riding?	□	□	□	□	□

	Extremely unlikely	Somewhat unlikely	Neutral	Somewhat likely	Extremely likely
How likely would you be to purchase these pants?	□	□	□	□	□

	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 these pants?	□	□	□	□	□

	Extremely low quality	Low quality	Neutral	High quality	Extremely high quality
What is the overall quality of these pants?	□	□	□	□	□

	Extremely unprotective	Somewhat unprotective	Neutral	Somewhat protective	Extremely protective
How protective do you think these pants are?	□	□	□	□	□

	Extremely unlikely	Somewhat unlikely	Neutral	Somewhat likely	Extremely likely
How likely would you be to wear these pants while riding?	□	□	□	□	□

	Extremely unlikely	Somewhat unlikely	Neutral	Somewhat likely	Extremely likely
How likely would you be to purchase these pants?	□	□	□	□	□

	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 these pants?	□	□	□	□	□

	Extremely low quality	Low quality	Neutral	High quality	Extremely high quality
What is the overall quality of these pants?	□	□	□	□	□

	Extremely unprotective	Somewhat unprotective	Neutral	Somewhat protective	Extremely protective
How protective do you think these pants are?	□	□	□	□	□

	Extremely unlikely	Somewhat unlikely	Neutral	Somewhat likely	Extremely likely
How likely would you be to wear these pants while riding?	□	□	□	□	□

	Extremely unlikely	Somewhat unlikely	Neutral	Somewhat likely	Extremely likely
How likely would you be to purchase these pants?	□	□	□	□	□

	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 these pants?	□	□	□	□	□

	Extremely low quality	Low quality	Neutral	High quality	Extremely high quality
What is the overall quality of these pants?	□	□	□	□	□

If “Men’s” was selected for Question 48

	Extremely unprotective	Somewhat unprotective	Neutral	Somewhat protective	Extremely protective
How protective do you think these pants are?	□	□	□	□	□

	Extremely unlikely	Somewhat unlikely	Neutral	Somewhat likely	Extremely likely
How likely would you be to wear these pants while riding?	□	□	□	□	□

	Extremely unlikely	Somewhat unlikely	Neutral	Somewhat likely	Extremely likely
How likely would you be to purchase these pants?	□	□	□	□	□

	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 these pants?	□	□	□	□	□

	Extremely low quality	Low quality	Neutral	High quality	Extremely high quality
What is the overall quality of these pants?	□	□	□	□	□

	Extremely unprotective	Somewhat unprotective	Neutral	Somewhat protective	Extremely protective
How protective do you think these pants are?	□	□	□	□	□

	Extremely unlikely	Somewhat unlikely	Neutral	Somewhat likely	Extremely likely
How likely would you be to wear these pants while riding?	□	□	□	□	□

	Extremely unlikely	Somewhat unlikely	Neutral	Somewhat likely	Extremely likely
How likely would you be to purchase these pants?	□	□	□	□	□

	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 these pants?	□	□	□	□	□

	Extremely low quality	Low quality	Neutral	High quality	Extremely high quality
What is the overall quality of these pants?	□	□	□	□	□

	Extremely unprotective	Somewhat unprotective	Neutral	Somewhat protective	Extremely protective
How protective do you think these pants are?	□	□	□	□	□

	Extremely unlikely	Somewhat unlikely	Neutral	Somewhat likely	Extremely likely
How likely would you be to wear these pants while riding?	□	□	□	□	□

	Extremely unlikely	Somewhat unlikely	Neutral	Somewhat likely	Extremely likely
How likely would you be to purchase these pants?	□	□	□	□	□

	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 these pants?	□	□	□	□	□

	Extremely low quality	Low quality	Neutral	High quality	Extremely high quality
What is the overall quality of these pants?	□	□	□	□	□

	Extremely unprotective	Somewhat unprotective	Neutral	Somewhat protective	Extremely protective
How protective do you think these pants are?	□	□	□	□	□

	Extremely unlikely	Somewhat unlikely	Neutral	Somewhat likely	Extremely likely
How likely would you be to wear these pants while riding?	□	□	□	□	□

	Extremely unlikely	Somewhat unlikely	Neutral	Somewhat likely	Extremely likely
How likely would you be to purchase these pants?	□	□	□	□	□

	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 these pants?	□	□	□	□	□

	Extremely low quality	Low quality	Neutral	High quality	Extremely high quality
What is the overall quality of these pants?	□	□	□	□	□

	Extremely unprotective	Somewhat unprotective	Neutral	Somewhat protective	Extremely protective
How protective do you think these pants are?	□	□	□	□	□

	Extremely unlikely	Somewhat unlikely	Neutral	Somewhat likely	Extremely likely
How likely would you be to wear these pants while riding?	□	□	□	□	□

	Extremely unlikely	Somewhat unlikely	Neutral	Somewhat likely	Extremely likely
How likely would you be to purchase these pants?	□	□	□	□	□

	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 these pants?	□	□	□	□	□

	Extremely low quality	Low quality	Neutral	High quality	Extremely high quality
What is the overall quality of these pants?	□	□	□	□	□

	Extremely unprotective	Somewhat unprotective	Neutral	Somewhat protective	Extremely protective
How protective do you think these pants are?	□	□	□	□	□

	Extremely unlikely	Somewhat unlikely	Neutral	Somewhat likely	Extremely likely
How likely would you be to wear these pants while riding?	□	□	□	□	□

	Extremely unlikely	Somewhat unlikely	Neutral	Somewhat likely	Extremely likely
How likely would you be to purchase these pants?	□	□	□	□	□

	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 these pants?	□	□	□	□	□

	Extremely low quality	Low quality	Neutral	High quality	Extremely high quality
What is the overall quality of these pants?	□	□	□	□	□

Demographics

(The participant will self-report the following information)

47. In what State do you currently live? _______________________________________

47. 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

47. Age: _______________ years

47. Sex

• Female

• Male

47. 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.):

_________________________________________________________________