Principal Survey

OMB No.: 1850-0803

Approval Expires: 9/30/2010

Mathematica Policy Research (MPR)

600 Maryland Avenue, SW, Suite 550

Washington, DC 20024

www.mathematica-mpr.com

For questions, call or email Tiffany Waits toll free at 888-633-8325 or [email protected].

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 1850-0803. The time required to complete this information collection is estimated to average 10 minutes per respondent, including the time to review instructions, gather the data needed, and complete and review the information collected. If you have any comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Education, Washington, DC 20202. If you have comments or concerns regarding the status of your individual submission of this form, write directly to: U.S. Department of Education, Institute of Education Sciences, 555 New Jersey Avenue, NW, Washington, DC 20208.

SCREENER

Intro (Preload name)

S1. Hello, my name is ___________, calling on behalf of the U.S. Department of Education regarding an important survey of former principals. May I please speak to [PARTICIPANT NAME]?

SAMPLE MEMBER SPEAKING 1 (S2)

SAMPLE MEMBER NOT AVAILABLE 2 (S3)

SAMPLE MEMBER COMES TO PHONE 3 (S2a)

DECEASED 4 set status= (STHANK2)

KNOWN PERSON - DOES NOT LIVE HERE/MOVED 5 (S7)

UNKNOWN PERSON - DOES NOT LIVE HERE 6 set status= (STHANK1)

HUNG UP DURING INTRODUCTION 7 set status = (END)

REFUSED r (S5)

Intro SM on phone

S2. I work for Mathematica Policy Research, a nationally recognized research company. You may have recently received a letter from the Department of Education regarding a survey of school principals we are conducting for them. We are not selling anything or asking for contributions, this is for research purposes only. Your name has been chosen as someone who may have formerly worked as a school principal. The interview will take less than 10 minutes.

CONTINUE 1 (Q1)

CALL BACK LATER 2 (S3 set appt)

HUNG UP DURING INTRODUCTION 6 set status = (END)

REFUSED r (S5)

Intro SM on phone

S2a.

S2. Hello, my name is ___________, calling on behalf of the U.S. Department of Education regarding an important survey of former principals. I work for Mathematica Policy Research, a nationally recognized research company. You may have recently received a letter from the Department of Education regarding a survey of school principals we are conducting for them. We are not selling anything or asking for contributions; this is for research purposes only. Your name has been chosen as someone who may have formerly worked as a school principal.

CONTINUE 1 (Q1)

CALL BACK LATER 2 (S4 set appt)

SEND LETTER 4 (S6)

HUNG UP DURING INTRODUCTION 5 set status = (END)

REFUSED r (S5)

(Gatekeeper indicates SM not available)

S3. When would be a good time to reach [SAMPLE MEMBER]?

MAKE HARD APPT. 1 (APPT SCREEN)

MAKE SOFT APPT 2 (APPT SCREEN)

NO APPT 3 (STHANK1)

(SM indicates not good time)

S4. Could I make an appointment with you at a time that is more convenient?

YES, MAKE HARD APPT. 1 (APPT SCREEN)

YES, MAKE SOFT APPT 2 (APPT SCREEN)

NO APPT 3 (STHANK1)

(Refusal Interim/Final?)

S5. Thank you for your time. Goodbye.

KNOWN SAMPLE MEMBER REFUSED - SOFT REFUSAL 1 Set status to XXX (END)

GATEKEEPER REFUSED - SOFT REFUSAL 2 Set status to XXX (END)

UNKNOWN REFUSAL - SOFT REFUSAL 3 Set status to XXX(END)

KNOWN SAMPLE MEMBER REFUSED - HARD REFUSAL 4 Set status to XXX (END)

GATEKEEPER REFUSED - HARD REFUSAL 5 Set status to XXX (END)

UNKNOWN REFUSAL - HARD REFUSAL 6 Set status to XXX(END)

(Request for letter)

S6. Let me make sure I have your correct mailing address:

CATI FILL FROM PRELOAD FILE

FILL FIRST NAME

FILL LAST NAME

FILL STREET ADDRESS

FILL CITY

FILL STATE

FILL ZIP

INTERVIEWER CONFIRM ADDRESS:

ADDRESS CORRECT, NO CHANGES NEEDED 1 Set Status = (STHANK3)

ADDRESS INCORRECT, CHANGES NEEDED 2 (S6_FNAME)

S6_FName: What is your first name? ___________________________

S6_LName: What is your last name?_____________________________

S6_Street Address: What is your address?:___________________________

S6_City: Your city?___________________________________________

S6_State: Your state?___________________

S6_ZIP: Your ZIP code?_______

GO TO STHANK3.

(Known sample member not living here )

S7. Do you have this person’s phone number?

YES. 1 (S7a)

NO 2 STATUS = X (STHANK1)

DON’T KNOW d STATUS = XX(STHANK1)

REFUSED r STATUS = XX(STHANK1)

S7a. Please tell me the telephone number, with the area code first, so I may contact [him/her] about this research study.

TELEPHONE NUMBER ( ) ___________________________

DON’T KNOW d (STHANK1)

REFUSED r (STHANK1)

STHANK1. Thank you for your time today, goodbye.

STHANK2. I’m so sorry to hear that. Thank you for your time today, goodbye.

STHANK3. Thank you. We’ll get a letter that explains this study out to you right away. It should arrive in about a week, and we’ll give you a call back. Thank you, goodbye.

APPT SCREEN:

HARD APPT: MONTH DAY YEAR TIME:______am/pm

SOFT APPT: MONTH DAY YEAR TIME:_______am/pm

(ALL)

1a. [New Screener, to confirm matching results]

Q1. First, I would like to confirm that you were a school principal during the 2006-07 school year, is that correct?

YES 1 (Q2)

NO 2 (Q1a)

DON’T KNOW d (Q1a)

REFUSED r (Q1a)

(Q1=2)

Q1a. The remaining questions are only for individuals who were principals in 2006-2007. Those are all the questions I have for you. Thank you for your participation.

END CALL

(Q1=1)

1b. [New Screener, to confirm matching results]

Q2. What is the name of the school where you were the principal during the 2006-07 school year?

INTERVIEWER: CONFIRM SCHOOL NAME AND SPELLING ARE CORRECT.

FILL SCHOOL NAME FROM SAMPLE FILE VARIABLE XX

school name: ____________(CATI FILL)___________

SCHOOL NAME CORRECT 1 (Q2city3)

SCHOOL NAME INCORRECT 2 (Q2a)

(Q2=2)

Q2a. INTERVIEWER: TYPE IN CORRECT SCHOOL NAME

school name: ____________________________________

(Q1=1)

1b. [New Screener, to confirm matching results]

Q2city. In what city is this school located?

INTERVIEWER: CONFIRM CITY NAME.

FILL CITY NAME FROM SAMPLE FILE VARIABLE XX

city name: ____________(CATI FILL)___________

CITY NAME CORRECT 1 (Q2state)

CITY NAME INCORRECT 2 (Q2citya)

(Q2city=2)

Q2citya. INTERVIEWER: TYPE IN CORRECT CITY NAME

city name: ____________________________________

(Q1=1)

1b. [New Screener, to confirm matching results]

Q2state. In what state is this school located?

INTERVIEWER: CONFIRM STATE.

FILL CITY NAMESTATE FROM SAMPLE FILE VARIABLE XX

state: ____________(CATI FILL)___________

STATE CORRECT 1 (Q3)

STATE INCORRECT 2 (Q2statea)

(Q2city=2)

Q2statea. INTERVIEWER: TYPE IN CORRECT STATE

state: ____________________________________

(Q1=1; FILL SCHOOL NAME IF Q2=1 OR FROM Q2a IF Q2=2)

3. [SASS 2007-08 Principal Survey Question 2]

Q3. How many years did you serve as the principal of [SCHOOL NAME]?

PROBE: Count part of a year as 1 year. If this is the school where you currently work, please count this year as 1 year.

| | | years

DON’T KNOW d

REFUSED r

(Q1=1; FILL SCHOOL NAME IF Q2=1 OR FROM Q2a IF Q2=2)

2. SASS Principal survey question 2)

Q4. Including your time as principal at [SCHOOL NAME], how many total years have you served as the principal of any school?

PROBE: Count part of a year as 1 year. If you are currently a school principal, please count this year.

| | | total years as principal

DON’T KNOW d

REFUSED r

Q1=1

Q4a. In total, at how many different schools have you served as a principal?

| | | total number of schools

Q1=1

19

Q5. What is your current main occupational status? Are you…

Mark Only One

Currently working as a school principal, 1 (Q6)

Working in education, but not as a principal, 2 (Q8)

Working outside the field of education, or 3 (Q8)

Not currently working for pay? 4 (Q8)

DON’T KNOW d (Q6)

REFUSED r (Q6)

Q5=1

1c. [New Screener, to confirm matching results]

Q6. Were you also a principal during the 2007-08 school year?

YES 1 (Q7)

NO 2 (Q8)

DON’T KNOW d (Q8)

REFUSED r (Q8)

Q6= 1

1c. NEW - Tiffany added

Q7. Was this the same school where you were the principal during the 2006-07 school year, or a different school?

SAME SCHOOL 1 (Q7a)

DIFFERENT SCHOOL 2 (Q28)

DON’T KNOW d (Q7a)

REFUSED r (Q7a)

(Q7=1)

Q7a. The remaining questions are only for principals who worked at a different school in 2007-2008. Those are all the questions I have for you today. Thank you for your participation.

END CALL

(Q5= 2, 3, or 4 OR Q6=2)

Q8. Next, I’m going to read a list of common reasons principals may decide to leave their position. For each one, please tell me if that reason was not at all important, slightly important, somewhat important, very important, or extremely important in your decision to leave your 2006-2007 position as a K-12 principal. The first one is…

INTERVIEWER: PROBE USING CATEGORIES AS NEEDED.

Decision to change schoolsleave school	Not at all important	Slightly important	Somewhat important	Very important	Extremely important
a. Retirement	1	2	3	4	5
b. School staffing action (e.g., reduction-in-force, lay-off, school closing, school reorganization, reassignment)	1	2	3	4	5
c. Better salary	1	2	3	4	5
d. Better benefits (e.g., health insurance, retirement plan)	1	2	3	4	5
e. To pursue a position other than that of a K-12 principal	1	2	3	4	5
f. To take courses to improve career opportunities within the field of education	1	2	3	4	5
g. To take courses to improve career opportunities outside the field of education	1	2	3	4	5
h. Dissatisfied with previous school or administrator assignment	1	2	3	4	5
i. Change in residence	1	2	3	4	5
j. Pregnancy or child rearing	1	2	3	4	5
k. Improve quality of life	1	2	3	4	5
lk. Other personal or family reasons	1	2	3	4	5
ml. Some other reason Please specify_____________	1	2	3	4	5

(Q5= 2, 3, or 4 OR Q6=2)

14. (switched schools between 06-07 and 07-08)

Q9. Of the reasons I just mentioned, which one do you consider to be the most important reason in your decision to leave your 2006-2007 position as a K-12 principal?

INTERVIEWER: CODE ONLY ONE.

Retirement 1

School staffing action (e.g., reduction-in-force, lay-off, school
closing, school reorganization, reassignment) 2

Better salary or benefits 3

Better benefits 4

To pursue a position other than that of a K-12 principal 5

To take courses to improve career opportunities within the field of
education 6

To take courses to improve career opportunities outside the field of
education 7

Dissatisfied with previous school or administrator assignment 8

Change in residence 9

Pregnancy/child rearing 10

Other personal or family reasons 11

DON’T KNOW d

REFUSED r

(Q5= 2, 3, or 4 OR Q6=2)

4. SASS 2007-08 Principal Survey Question 3]

Q9a. Before you became a principal, how many total years had you served as an assistant or vice principal of any school?

INTERVIEWER: Count part of a year as 1 year. If none, please enter 0.

| | | total years as assistant or vice principal

(Q5= 2, 3, or 4 OR Q6=2)

4. SASS 2007-08 Principal Survey Question 3]

Q10. Before you became a principal, how many years of elementary, middle, or secondary teaching experience did you have?

INTERVIEWER: Count part of a year as 1 year. If none, please enter 0.

| | | total years teaching

DON’T KNOW d

REFUSED r

(Q5= 2, 3, or 4 OR Q6=2)

5. [SASS 2007-08 Principal Survey Question 7-The response categories under yes are new, and may require further response options for coding purposes.]

Q11. Before you became a principal, did you have any management experience outside of the field of education?

YES 1 (Q12)

NO 2 (Q14)

DON’T KNOW d (Q14)

REFUSED r (Q14)

(Q11=1)

New

Q12. Please describe the management experience you had before becoming a principal.

(Q11=1)

New

Q13. How many years of management experience did you have before becoming a principal?

| | | total years

DON’T KNOW d

REFUSED r

(Q5= 2 or 3 OR Q6=2. Else go to Q16)

20. [TFS 2003-04 Current Teacher Survey Question 20]

Q14. How would you rate your current position relative to your previous position as a K-12 principal in terms of each of the following aspects?

INTERVIEWER: CODE ONE ON EACH LINE.

	Better in current position	Not better or worse	Better as principal	DON’T KNOW	REFUSED
a. Salary	1	2	3	d	r
b. Benefits (e.g., health insurance, retirement plan)	1	2	3	d	r
c. Opportunities for professional advancement or promotion	1	2	3	d	r
d. Opportunities for professional development	1	2	3	d	r
e. Opportunities for learning from colleagues	1	2	3	d	r
f. Social relationships with colleagues	1	2	3	d	r
g. Recognition and support from administrators/managers	1	2	3	d	r
h. Safety of environment	1	2	3	d	r
i. Influence over workplace policies and practices	1	2	3	d	r
j. Autonomy or control over your own work	1	2	3	d	r
k. Professional prestige	1	2	3	d	r
l. Procedures for performance evaluation	1	2	3	d	r
m. Manageability of workload	1	2	3	d	r
n. Ability to balance personal life and work	1	2	3	d	r
o. Availability of resources and materials/equipment for doing job	1	2	3	d	r
p. General work conditions	1	2	3	d	r
q. Job security	1	2	3	d	r
r. Intellectual challenge	1	2	3	d	r
s. Sense of personal accomplishment	1	2	3	d	r
t. Opportunities to make a difference in the lives of others difference in the lives of others	1	2	3	d	r

(Q5= 2 or 3 OR Q6=2. Else go to Q16)

21.

Q15. Thinking about all the factors that influence your job satisfaction, overall, how satisfied are you with your current position compared to the position of a K-12 principal? Would you say you are…

More satisfied as a principal, 1

More satisfied in your current position, or 2

There is no difference? 3

DON’T KNOW d

REFUSED r

(Q5= 2, 3, or 4 OR Q6=2)

Q16. Would you consider returning to the position of a K-12 principal?

YES 1 (Q17)

NO 2 (Q20intro)

DON’T KNOW d (Q20intro)

REFUSED r (Q20intro)

(Q16=1)

Q17. At what level would you most like to work…

Elementary, including kindergarten, 1

Junior or middle high school, or 2

Senior high school? 3

DON’T KNOW d

REFUSED r

(Q16=1)

Q18. What is the lowest salary, not including benefits, you would accept to return to the position of a K-12 principal?

$ |__|__|__| , |__|__|__| per year

DON’T KNOW d

REFUSED r

(Q16=1)

Q19. How soon might you return to the position of a K-12 principal? Would you say…

Later this school year (2008-2009), 1

Next school year (2009-2010), 2

Not next year, but within the next 5 years, 3

More than 6 years from now, or 4

Are you undecided? 5

DON’T KNOW d

REFUSED r

DEMOGRAPHIC INFORMATION

Q20intro. The next few questions are about your background.

(Q5= 2, 3, or 4 OR Q6=2)

[SASS 2007-08 Principal Survey Question 39]

Q20. Are you male or female?

Male 1

Female 2

DON’T KNOW d

REFUSED r

(Q5= 2, 3, or 4 OR Q6=2)

[SASS 2007-08 Principal Survey Question 40]

Q21. Are you of Hispanic or Latino origin?

YES 1

NO 2

DON’T KNOW d

REFUSED r

(Q5= 2, 3, or 4 OR Q6=2)

[SASS 2007-08 Principal Survey Question 41a]

Q22. What is your race? Are you…

INTERVIEWER: Mark one or more

White, 1 (Q24)

Black or African-American, 2 (Q24)

Asian, 3 (Q24)

Native Hawaiian or other Pacific Islander, or 4 (Q24)

American Indian or Alaska Native? 5 (Q23)

DON’T KNOW d (Q24)

REFUSED r (Q24)

(Q22=5)

[SASS 2007-08 Principal Survey Question 41b]

Q23. Are you enrolled in a state or federally recognized tribe?

YES 1

NO 2

DON’T KNOW d

REFUSED r

(Q5= 2, 3, or 4 OR Q6=2)

Q24. In what year were you born?

19| | | year

DON’T KNOW d

REFUSED r

(Q5= 2, 3, or 4 OR Q6=2)

6. [SASS 2007-08 Principal Survey Question 8]

Q25. What is the highest degree you have earned?

INTERVIEWER: READ LIST IF NECESSARY. CODE ONE ANSWER.

DOES NOT HAVE A DEGREE 1 (Q28)

ASSOCIATE DEGREE 2 (Q28)

BACHELOR’S DEGREE (B.A., B.S., ETC.) 3 (Q25a)

MASTER’S DEGREE (M.A., M.A.T., M.B.A., M.ED.,

M.S., ETC.) 4 (Q25b)

EDUCATIONAL SPECIALIST OR PROFESSIONAL

DIPLOMA (AT LEAST ONE YEAR BEYOND A

MASTER’S LEVEL) 5 (Q25c)

DOCTORATE OR FIRST PROFESSIONAL DEGREE

(PH.D., ED.D., M.D., L.L.B., J.D., D.D.S.) 6 (Q25d)

DON’T KNOW d (Q26)

REFUSED r (Q26)

(Q25=3)

Q25a. What was your field or fields of study?

_________________________________________________________________

DON’T KNOW d

REFUSED r

(Q25=4)

Q25b. What was your field or fields of study?

_________________________________________________________________

DON’T KNOW d

REFUSED r

(Q25=5)

Q25c. What was your field or fields of study?

_________________________________________________________________

DON’T KNOW d

REFUSED r

(Q25=6)

Q25d. What was your field or fields of study?

_________________________________________________________________

DON’T KNOW d

REFUSED r

IF Q25= 3, GO TO Q28.

IF Q25= 4 OR 5, GO TO Q27.

IF Q25 = 6, GO TO Q26.

(Q25=6 OR d or r)

[New item, added per Mark Schneider]

Q26. Do you have a doctorate degree in Education Administration?

YES 1

NO 2

DON’T KNOW d

REFUSED r

(Q25= 4, 5, or 6 or d or r)

7. [SASS 2007-08 Principal Survey Question 9]

Q27. Do you have a master’s degree, educational specialist, or professional diploma (at least one year beyond a master’s level) in Education Administration?

YES 1

NO 2

DON’T KNOW d

REFUSED r

(Q25=2,3, or 4, OR Q6= 2 OR Q7=2)

13. [SASS 2007-08 Principal Survey Question 43]

Q28. What was your annual salary in 2007-2008 before taxes and deductions?

(If your position includes multiple duties [e.g., you teach a class and serve as principal at this school]), please include your entire salary before taxes and deductions.)

PROBE: Include earnings from commissions, merit pay bonuses, and other bonuses from this job. Record earnings in whole numbers.)

Please report in whole dollars.

$ |__|__|__| , |__|__|__| per year

DID NOT WORK LAST YEAR 1

DON’T KNOW d

REFUSED r

IF Q28= R OR D, GO TO Q28A. ELSE, GO TO Q29.

(Q28= r or d)

Q28a. Do you know if your annual salary in 2007-2008 before taxes and deductions was….

$30,000 or less, 1

$30,0001 to $40,000, 2

$40,001 to $50,000, 3

$50,001 to $60,000, 4

$60,001 to $75,000, 5

$75,001 to $100,000, or 6

Over $100,000? 7

DON’T KNOW d

REFUSED r

(Q5=2, 3 OR Q6=2 OR Q7=2. Else go to Q30)

14. [TFS 2007-08 Former Teacher Survey, New item cognitive testing completed]

Q29. What are your estimated annual before-tax earnings at your current job?

(Include earnings from commissions, merit pay bonuses, and other bonuses from this job. Record earnings in whole numbers.)

$ |__|__|__| , |__|__|__| per year

DON’T KNOW d

REFUSED r

IF Q29= R OR D, GO TO Q29A. ELSE, GO TO Q30.

(Q29= r or d)

Q29a. Do you know if your annual salary in 2007-2008 before taxes and deductions was….

$30,000 or less, 1

$30,0001 to $40,000, 2

$40,001 to $50,000, 3

$50,001 to $60,000, 4

$60,001 to $75,000, 5

$75,001 to $100,000, or 6

Over $100,000? 7

DON’T KNOW d

REFUSED r

(Q5= 2, 3, or 4 OR Q6=2 OR Q7=2)

15. [TFS 2007-08 Former Teacher Survey, New item cognitive testing completed]

Q30. Are you currently receiving a pension from a teacher/principal retirement system?

YES 1 (Q31)

NO 2 (Q32)

DON’T KNOW d (Q32)

REFUSED r (Q32)

(Q30=1)

15. [TFS 2007-08 Former Teacher Survey, New item cognitive testing completed]

Q31. How much is that, before taxes?

INTERVIEWER: ROUND TO THE NEAREST DOLLAR. CODE WHETHER AMOUNT IS PER MONTH OR PER YEAR.

$ |__|__|__| , |__|__|__| .|__|__|

AMOUNT PER MONTH 1

AMOUNT PER YEAR 2

DON’T KNOW d

REFUSED r

(Q6=2, 3, or 4, OR Q6= 2 OR Q7=2)

Q32. Did you receive an incentive to retire from the position of principal at your 2006-2007 school?

YES 1 (Q33)

NO 2 (Q34)

DON’T KNOW d (Q34)

REFUSED r (Q34)

(Q32=1)

Q33. Would you have remained in your position as a principal if you had not received an incentive to retire?

YES 1

NO 2

DON’T KNOW d

REFUSED r

CONTACT INFORMATION

Q34. That concludes the interview. We may do a brief follow-up at a later time in order to gain additional information on former principals’ movements in the labor force. Can you verify your current contact information?

INTERVIEWER: VERIFY NAME AND CONTACT INFORMATION. IF INFORMATION IS THE SAME AS DISPLAYED CODE 0. IF INFORMATION IS NOT THE SAME AS DISPLAYED CODE 1 AND ENTER CORRECT INFORMATION.

DISPLAY FROM SAMPLE FILE PRELOADED INFORMATION:

FULL NAME

STREET ADDRESS

CITY

STATE

ZIP

TELEPHONE NUMBER

INFORMATION IS SAME 0 (Q33)

INFORMATION INCORRECT, NEED TO MAKE CHANGE 1 (Q34)

DON’T KNOW d (Q34)

REFUSED r (Q34)

Q34_FName: What is your first name? ___________________________

DON’T KNOW d

REFUSED r

Q34_LName: What is your last name?_____________________________

DON’T KNOW d

REFUSED r

Q34_Street Address: What is your address?:___________________________

DON’T KNOW d

REFUSED r

Q34_City: Your city?___________________________________________

DON’T KNOW d

REFUSED r

Q34_State: Your state?___________________

DON’T KNOW d

REFUSED r

Q34_ZIP: Your ZIP code? ___________________

DON’T KNOW d

REFUSED r

Q34_HomePhone: What is your home telephone number, area code first? ______________

DON’T KNOW d

REFUSED r

Q34_Phonename: What is the name of the person the telephone number is listed under?__________________

DON’T KNOW d

REFUSED r

Q34_CellPhone: What is your cell phone number?__________________________

DON’T KNOW d

REFUSED r

Q34_Home Email: Do you have a home email address?

YES 1

NO 2 (Q34_workemail)

DON’T KNOW d (Q34_workemail)

REFUSED r (Q34_workemail)

Q34_CollectHEmail: What is that email address?

DON’T KNOW d

REFUSED r

Q34_PrivateHemail: Are you the only person who receives email at this email address?

YES 1

NO 2

DON’T KNOW d

REFUSED r

Q34_Work Email: Do you have a work email address?

YES 1

NO 2 (Q35)

DON’T KNOW d (Q35)

REFUSED r (Q35)

Q34_CollectWEmail: What is that email address?

DON’T KNOW d

REFUSED r

Q34_PrivateWemail: Are you the only person who receives email at this email address?

YES 1

NO 2

DON’T KNOW d

REFUSED r

[TFS 2003-04 Former Teacher Survey Question 37]

Q35. What are the names and addresses of two other people who would know where to get in touch with you during the coming years?

(Please do not list more than one person who now lives with you.)

A. FIRST PERSON

Mr./Ms./Dr. First Name Last Name

relationship of this person to you

Street Apt. Number

City State Zip

Home Phone Number (Include Area Code) name of person telephone is listed under

DON’T KNOW d (END CALL)

REFUSED r (END CALL)

B. Thank you. Can I get similar information for one a second contact person?

INTERVIEWER: COLLECT INFORMATION ON A SECOND CONTACT PERSON

Mr./Ms./Dr. First Name Last Name

relationship of this person to you

Street Apt. Number

City State Zip

Home Phone Number (Include Area Code) name of person telephone is listed under

DON’T KNOW d

REFUSED r

Those are all the questions I have for you today. I thank you very much for your participation in this survey. Goodbye.