Show Card - Respondent

CARD C

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Type of Place
	Individual(s) or family	Group Living	Other Place	Institution
Not on a farm…	House Townhouse Condo Apartment Flat Mobile home	Dormitory Residence hall Fraternity apartment Sorority apartment Fraternity house Sorority house Military barracks Boarding house Rooming house Group home	Hotel Motel Shelter	Jail Prison Detention center Work release center Hospital Treatment center
On a farm or ranch…	House Apartment Mobile home Townhouse	Group home
Homeless Other Type of Housing

Average Grades in High School

Mostly below Ds

MostlyDs

About half Cs and half Ds

MostlyCs

About half Bs and half Cs

MostlyBs

About half As and half Bs

Mostly As

• As to Cs

• Ungraded

• Other (please describe)

Individual Math Courses

• General math

• Basic math

• Vocational math

• Elementary algebra

• Algebra I

• Intermediate algebra

• Algebra II

• Advanced algebra

• Geometry

• Trigonometry

• Pre-calculus

• Calculus

• Other advanced math

• Other math

Science Courses

Who Provided You with Financial Assistance

Your Parents		Your Grandparents		Other Relatives, Friends, or Other Non-Relatives		None
Your biological parents together
Your mother (and step-father)
Your father (and step-mother)

Amount Still Owed on Loans

(A) $1 - 1,000

(B) 1,001 - 2,500

(C) 2,501 - 5,000

(D) 5,001 - 10,000

(E) 10,001 - 25,000

(F) 25,001 - 50,000

(G) More than $50,000

Types of Financial Assistance

Fellowships Scholarships Grants	Fee waivers or reductions Tuition waivers or reductions	College work-study Employer assistance
A government subsidized or private loan Other types of assistance including JTPA, Jobs or other government provided assistance
None

Various Courses

• General introductory course in computer literacy

• Word processing course

• Computer programming course

• Other computer courses

• Shop or industrial arts

• Home economics

School-to-Work Programs

Activity	Description
Cooperative education	- combining academic and vocational studies with a job in a related field
Internship or apprenticeship	- working for an employer to learn about a particular occupation or industry
Job shadowing	- spending time following workers at a work site
Mentoring	- being matched with an individual in an occupation
School-sponsored enterprise	- the production of goods or services by students for sale to or use by others
Tech prep	- a planned program of study with a defined career focus that links secondary and post-secondary education
None

Reason for Not Working

• No clients/customers

• Didn’t have materials/equipment needed

• Financial problems

• Temporary/seasonal job ended for period, but later resumed

• Unpaid vacation

• Going to school

• In the Armed Forces

• Pregnancy

• Had health problems

• Had problems with child care

• Had other personal or family reason

• Did not want to work

• Some other reason

Why You Stopped Working

• Sold the business

• Not enough business

• End of temporary or seasonal business

• Need new capital equipment

• Started a different business

• Stopped for a pregnancy or family reasons

• Stopped to look for another job

• Stopped to take another job

• Stopped to devote more time to school work

• Stopped to return to school

• Stopped for other (please describe) reasons

• Business failed or bankruptcy

• Closed business down or dissolved partnership

Why You Left This Job

• Layoff

• Company, office, workplace, or plant closed

• End of temporary or seasonal job

• Discharged or fired

• Program/project/job ended

• Quit for pregnancy or family reasons

• Quit to look for another job

• Quit to take another job

• Quit to start a business

• Quit to devote more time to school work

• Quit to return to school

• Quit for other reasons (please describe)

• Moved away from job

• No transportation/Transportation problems

• Incarcerated/Jailed/Legal problems

• Quit because of respondent’s ill health, disability, or medical problems

• Quit because didn’t like job/assignment, boss, coworkers, pay, or benefits­

• Retired

• Job assigned through a temporary help agency/contract firm became permanent

Type of Schedule

• Night shift

• Day shift

• Evening shift

Benefits Some Employers Make Available

Type of Benefit		Description
Medical, Surgical or Hospitalization Insurance		- Insurance that pays some or all of your medical expenses.
Life Insurance		- Insurance that pays your survivors in the event of your death.
Dental Insurance or Other Dental Coverage		- Insurance that helps pay for the care of your teeth.
Paid Parental (Maternity or Paternity) Leave		- Leave during the period before and after the birth or adoption of a child for which you ARE paid.
Unpaid Parent (Maternity or Paternity) Leave		- Leave during the period before and after the birth or adoption of a child for which you ARE NOT paid.
Retirement Plan or Pension Other than Social Security		- A plan that helps you save for or puts money away for your retirement.
Flexible Work Schedule		- Allows for scheduling options on your job.
Tuition Reimbursement		- Pays for schooling.
Child Care		- Company provided or subsidized.
Stock Ownership		- Allows employees to purchase company stock at reduced rates.
None

How You Looked for Work

• Contacted employer directly

• Contacted employment agency

• Through friends or relatives

• Contacted a school placement center

• Sent out resumes or filled out applications

• Placed an ad

• Checked union or professional registers

• Looked at ads

• Employer contacted you directly

• Attended Job Fair

• Searched on the Internet/On-line

• Other (please describe)

Main Reason for Not Working

• On strike

• On layoff

• Quit job but returned to same employer

• Job ended for a period of time but began again

• Some other reason you went on unpaid vacation/leave

Reason for Unpaid Vacation/Leave

• Going to school

• In the Armed Forces

• Pregnancy

• Had health problems

• Had problems with child care

• Had other personal or family reason

• School/Plant/Firm temporarily closed

• Did not want to work

• Some other reason

Dollar Ranges

(A) $1 - 1,000

(B) 1,001 - 2,500

(C) 2,501 - 5,000

(D) 5,001 - 10,000

(E) 10,001 - 25,000

(F) 25,001 - 50,000

(G) 50,001 - 100,000

(H) 100,001 – 250,000

(I) More than $250,000

How You Looked for a Job

• Contacted employer directly or interviewed

• Contacted public employment agency

• Contacted private employment agency

• Contacted friends or relatives

• Contacted a school or university employment center

• Sent out resumes or filled out application

• Checked union or professional registers

• Placed or answered ads

• Other active methods (such as bidding on a contract or auditioning for a part in a play)

• Looked at ads

• Attended job training programs or courses

• Nothing

• Other Passive Methods (such as studying for a real estate license or picking up a job application)

Some Sources of Occupational Training Programs Include

 apprenticeship programs

 business schools

 company or military training

 correspondence courses

 cosmetology schools

 employer training programs

 night schools

 nursing courses

 vocational or technical institutes or schools

Reason You Enrolled in Training

• The training was associated with a promotion or job advancement

• The training was associated with looking for a new job

• The training was necessary to obtain a license or certificate

• The training was necessary when job began

• The training was part of a regular program to maintain and upgrade employee skills

• The training was associated with the introduction of new methods or processes on the job

• Other (please describe)

Skills Learned From This Training

• Upgrade your computer skills

• Upgrade your reading and/or writing skills

• Upgrade your mathematics skills

• Upgrade your skills in working as a team or problem solving

• About health or safety procedures

• How to operate or repair equipment

• How to be a more effective sales person

• How to be a better supervisor/manager

• Statistical process control or total quality management

• Equal opportunity or diversity sensitivity training

• Other skill

• No skills learned

Religions

CATHOLIC	PROTESTANT	JEWISH	OTHERS	NONE/NO RELIGION
Roman Catholic	Baptist Disciples of Christ (or the Christian Church) Episcopal/Anglican Holiness (Nazarene, Wesleyan, Free Methodist) Lutheran Methodist Nondenominational Christian (also includes Bible Church) Pentecostal (Assembly of God, Pentecostal Holiness) Presbyterian Reform (or Reformed Church in America or Christian Reformed Church) United Church of Christ (or Congregationalist or Evangelical Reformed Church) Jehovah’s Witness Seventh Day Adventist Other Protestant	Jewish – Conservative Jewish – Orthodox Jewish – Reform Other Jewish	Eastern Orthodox Hindu or Buddhist Mormon (all types of Latter Day Saints) Muslim (or Moslem or Islam) Native American Tribal Religion Unitarian Other Organized Religion (please describe)	Agnostic (don’t know if there is a God) Atheist (confident there is no God) Personal Philosophy

Amount Received for Unemployment

A B C D E F

$1 $100 $150 $200 $250 $350 or more------------------>

A. $1 - $100

B. $101 - $150

C. $151 - $200

D. $201 - $250

E. $251 - $350

F. More than $350

Amount Received

(A) $1 – 100

(B) 101 – 200

(C) 201 – 300

(D) 301 – 400

(E) 401 – 500

(F) 501 – 600

(G) 601 – 700

(H) 701 – 800

(I) 801 – 900

(J) 901 - 1,000

(K) 1,001 - 1,250

(L) More than $1,250

Cost to Purchase Food Items

(A) $1 – 20

(B) 21-40

(C) 41-60

(D) 61-80

(E) 81-100

(F) More than $100

Income after Expenses

(B) $1 - 5,000

(C) $5,001 - 10,000

(D) $10,001 - 25,000

(E) $25,001 - 50,000

(F) $50,001 - 100,000

(G) $100,001 - 250,000

(H) More than $250,000

• (A) Lost or Would Lose Money

Dollar Ranges

(A) $1 - 5,000

(B) 5,001 - 10,000

(C) 10,001 - 25,000

(D) 25,001 - 50,000

(E) 50,001 - 100,000

(F) 100,001 - 250,000

(G) More than $250,000

Dollar Ranges

(A) $1 - 1,000

(B) 1,001 - 2,500

(C) 2,501 - 5,000

(D) 5,001 - 10,000

(E) 10,001 - 25,000

(F) 25,001 - 50,000

(G) More than $50,000

Dollar Ranges

(A) $1 – 500

(B) 501 - 1,000

(C) 1,001 - 2,500

(D) 2,501 - 5,000

(E) 5,001 - 7,500

(F) 7,501 - 10,000

(G) More than $10,000

Dollar Ranges

(A) $1 - 1,000

(B) 1,001 - 2,500

(C) 2,501 - 5,000

(D) 5,001 - 10,000

(E) 10,001 - 25,000

(F) 25,001 - 50,000

(G) 50,001 – 100,000

(H) More than 100,000

Dollar Ranges

(A) $1 - 5,000

(B) 5,001 - 10,000

(C) 10,001 - 25,000

(D) 25,001 - 50,000

(E) 50,001 - 100,000

(F) 100,001 - 250,000

(G) 250,001 - 500,000

(H) More than $500,000

Dollar Ranges

(A) $1 - 25,000

(B) 25,001 - 50,000

(C) 50,001 - 100,000

(D) 100,001 - 250,000

(E) 250,001 - 500,000

(F) 500,001 - 1,000,000

(G) More than $1,000,000

Who Loaned You Money?

Your family	Mother Father Sisters Brothers	Step-mother Step-father Step-sisters Step-brothers	Grandparents	Other relatives
Your spouse’s or partner’s family	Mother Father Sisters Brothers	Step-mother Step-father Step-sisters Step-brothers	Grandparents	Other relatives
Friends or other non-relatives

Types of Child Care Arrangements

Informal Care	Spousal or Partner Care	- child is cared for by your live-in spouse or partner who may or may not be the child’s father
	Relative Care	- child is cared for by your relative or in-law, including the child’s father if the father does not live with the child; this type of care does not include care given by any of your other children
	Sibling Care	- child is cared for by one of your other children
	Self Care	- child cares for herself or himself
	Non-Relative Care	- child is cared for by a baby-sitter, nanny, boyfriend, or friend in the child’s home
Formal Care	Family Day-Care	- child is cared for by a non-relative in the non-relative’s home -even if your child is the only one for whom the provider cares
	Child Care Center	- child is cared for in a preschool, Head Start, Montessori, day-care center, nursery school, or other pre-kindergarten program
	Formal Schooling	- child attends a kindergarten, elementary, middle, or junior high school
	After-School Care	- child receives formal care after school

Relatives who Provide Child Care

Cause of Death

• Heart Attack/Stroke

• Accident

• Cancer

• Old Age

• Emphysema

• Other (specify)

Relatives (including in-laws)

Type of Relationship

SPOUSE Wife Husband	PARENTS Mother Father Adoptive Mother Adoptive Father Step-mother Step-father Foster Mother Foster Father (GREAT) GRANDPARENTS Grandmother (Biological or Social) Grandfather (Biological or Social) Great-grandmother (Biological or Social) Great-grandfather (Biological or Social) Great-great-grandmother Great-great-grandfather NON-RELATIVES Daughter of Lover/Partner Son of Lover/Partner Roommate Lover/Partner Other Non-relative Mother’s Boyfriend/Partner Father’s Girlfriend/Partner	IN-LAWS Mother-in-law Father-in-law Sister-in-law Brother-in-law Daughter-in-law Son-in-law Grandmother-in-law Grandfather-in-law Great-grandmother-in-law Great-grandfather-in-law Aunt-in-law Uncle-in-law Cousin-in-law OTHER RELATIVES Aunt (Biological or Social) Uncle (Biological or Social) Great Aunt Great Uncle Niece (Biological or Social) Step-niece (Biological or Social) Foster-niece (Biological or Social) Adoptive Niece (Biological or Social) Nephew (Biological or Social) Step-nephew (Biological or Social) Foster Nephew (Biological or Social) Adoptive Nephew (Biological or Social) Female Cousin (Biological or Social) Male Cousin (Biological or Social) Other Relative
CHILDREN Daughter (Biological) Son (Biological) Step-daughter Step-son Adoptive Daughter Adoptive Son Foster Daughter Foster Son
(GREAT) GRANDCHILDREN Granddaughter (Biological or Social) Grandson (Biological or Social) Great-granddaughter Great-grandson
SIBLINGS Sister (Full) Brother (Full) Sister (Half) Brother (Half) Sister (Step) Brother (Step) Sister (Adoptive) Brother (Adoptive) Sister (Foster) Brother (Foster)

Current Immigration Status

• Applicant for naturalization to become U.S. citizen

• Have a “Green Card”—Lawful permanent resident of the U.S. (LPR)

• Applicant for Lawful permanent residence (LPR)

• Refugee/Asylee/Entrant

• On temporary visa

• Living outside of the U.S. at this time

• Other

How Often I Eat Fruit

• I do not typically eat fruit

• 1 to 3 times

• 4 to 6 times

• 1 time per day

• 2 times per day

• 3 times per day

• 4 or more times per day

How Often I Eat Vegetables

• I do not typically eat vegetables

• 1 to 3 times

• 4 to 6 times

• 1 time per day

• 2 times per day

• 3 times per day

• 4 or more times per day

Health Conditions

• Asthma

• Cardiovascular or heart condition

• Anemia

• Diabetes

• Cancer

• Epilepsy

• HIV/AIDS

• Sexually transmitted disease other than HIV/AIDS

• Other

Disagreement/Agreement Scale

1 2 3 4 5 6 7

Disagree Disagree Disagree Neither Agree Agree Agree

Strongly Moderately a little Agree a little Moderately Strongly

nor

Disagree

Activities You Engaged In

• Employer-directed travel

• Employer-directed training

• Meal break

• Rest break

• Personal business

• Normal work activity

• Other activity (SPECIFY)

Frequencies

• All of the Time

• Most of the Time

• A Good Bit of the Time

• Some of the Time

• A Little of the Time

• None of the Time

Ladder of Life

	10 Best Possible Life
	0 Worst Possible Life

Dollar Ranges

1. $1 – 10

2. 11 – 25

3. 26 – 50

4. 51 – 100

5. 101 – 150

6. 151 – 250

7. More than $250

Dollar Ranges

1. $0

2. 1 – 5,000

3. 5,001 - 10,000

4. 10,001 - 25,000

5. 25,001 - 50,000

6. 50,001 - 100,000

7. 100,001 - 250,000

8. More than $250,000