Recruitment Screener

Attachment 3

Recruitment Screener

Screener for the National Crime Victimization Survey Usability Tests

NAME______________________________ PHONE_____________________________

RESPONDENT Number ____________________

I have to ask you some questions to determine whether you are eligible for our study. It will only take a few minutes.

1. What is your age?

|___|___|

AGE

IF AGE 17 OR YOUNGER…………………………...(END STATEMENT)

AGES 18+ (GO TO 2)

2. Have you been the victim of a crime in the last 12 months?

YES 1

NO 2 (GO TO 5)

2. Can you briefly explain what happened?

2. What month did it happen?

_________ (MONTH) (If more than 12 months ago, GO TO END)

5-A. Are you of Hispanic, Latino or Spanish origin?

YES…………………………………………………………………... 1

NO……………………………………………………………. ………2

2. What is your race?  Please select one or more. 

White…………………………………………………….. 1

Black or African American……………………………. ….2 Asian……………………………………………………….3

Native Hawaiian or other Pacific Islander… ……………... 4

American Indian or Alaska Native ……………………….. 5

6. What is the highest level of education you have completed?

8th grade, some high school, but not a diploma……………….1

12 grade/high school diploma or GED…………………………2

Some college, Associate’s degree, Bachelor’s degree or higher..3

ELIGIBLE RESPONDENTS – AGE 18+ AND CRIME VICTIMS. It appears you are eligible for our study. We’d like to schedule an interview here at Westat. Let me read you the days and times I have available, and you can tell me what would be best for you. This will take about 1 hour of your time and we will pay you $40 cash. May I please have your full name and address? (We need your address so that we can send you directions to Westat. It will include a map that shows you exactly where the room is).

Name:

Address:

E-mail address:

I will send the directions out to you shortly. If you have to cancel your interview, please call back so that we can schedule someone in your place, OK? You can reach me at: [Recruiter’s Phone Number].

END STATEMENT: It appears that you are probably not eligible for our study. Thank you very much for your interest and willingness to help out. We will call you if it turns out that we need people who:

1. [are younger than age 18]

2. [have not been a crime victim]

3. [crime victim, but longer ago than past 12 months]