Form Friends and Family Friends and Family Friends and Family Form

Friends and Family Small-scale Test

1	Did you receive this email directly from the U.S. Census Bureau, or did a family member or friend forward the email to you and ask you to complete the survey?
	I received this email directly from the U.S. Census Bureau
	A family member or friend forwarded me the email

2	Are you male or female?
	Male
	Female

3	What is your age?
	Less than 18 years old
	18-24
	25-34
	35-44
	45-54
	55-64
	65 -74
	75 or older

4	Are you of Hispanic or Latino origin?
	Yes > SHOW: “Hispanics can be any race” in Q5
	No

5	(IF HISPANIC – YES IN Q4 - SHOW: “Hispanics can be of any race.”) What is your race? You may select one or more.
	White
	Black or African American
	American Indian or Alaska Native
	Asian
	Native Hawaiian or other Pacific Islander

6	What is your highest level of education?
	Less than high school diploma or GED
	High school diploma or GED
	Some college
	College graduate or professional degree

7	In the last 3 months, have you attended school or college?
	Yes
	No

8	Last week, did you work for pay at a job (or business)?
	Yes
	No

9	Did you work for …
	A government (federal, state, local) office or agency?
	A college or university?
	Another private organization or were self-employed?

10	What was your occupation?
	Education, training, and library (e.g., teachers, professors)
	Community and social service (e.g., social workers)
	Management, business, and science occupations (e.g., human resources workers, economists)
	Legal occupations
	Healthcare practitioners and technical occupations
	Healthcare support occupations
	Sales and office occupations (e.g., real estate agents, billing clerks)
	Other

Thank you very much for participating in this important study.

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