Various Demographic Area Pretesting Activities

Generic Clearance for Questionnaire Pretesting Research

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Various Demographic Area Pretesting Activities

OMB: 0607-0725

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Participant #________________



Demographic Information



1. In what month and year were you born? _________________ __________________

month year


2. What is the highest grade or year of school you have completed?

Shape1 G Less than high school

Shape2 G Completed high school

Shape3 G Some college, no degree (indicate area of study: ____________________________________)

Shape4 G Associate’s degree (AA/AS) (indicate area of study: __________________________________)

Shape5 G Bachelor’s Degree (BA/BS) (indicate area of study: __________________________________)

Shape6 G Post-Bach degree (indicate degree and area of study: ________________________________)


3. Are you male or female?

Shape7 G Male

Shape8 G Female


4. Are you of Hispanic, Latino, or Spanish origin?

Shape9 G Yes

Shape10 G No


5. What is your race? Choose one or more races.

Shape11 G White

Shape12 G Black or African American

Shape13 G American Indian or Alaska Native

Shape14 G Asian

Shape15 G Native Hawaiian or Other Pacific Islander





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