Team Nutrition Cooks - State, Local, and Tribal Government

Attachment H – Demographics for Parents and Program Operators

OMB BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not 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 0584-0524.  The time required to complete this information collection is estimated to average 2 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

What is your gender?

☐ Male

☐ Female

☐ Other

How old are you? __________ (in years)

What is the highest level of education you completed?

☐ Less than high school degree or equivalent

☐ High school graduate (GED or diploma)

☐ Some college courses completed

☐ Associate degree (2-year)

☐ Bachelor’s degree (4-year)

☐ Post-graduate degree (master’s or doctorate)

Are you of Hispanic or Latin American origin?

☐ Yes

☐ No, not of Hispanic, Latino/a, or Spanish origin

☐ Don’t know/Not sure

What is your race? (One or more categories may be selected)

☐ White

☐ Black/African American

☐ American Indian or Alaska Native

☐ Asian

☐ Native Hawaiian/Other Pacific Islander

☐ Some other race

2