Recruitment screener

13

Civic Engagement and Volunteerism Additional Screener Questions

Section 1: Questions to Pull from Universal Screener

1. What is your name?

First name: [ ]

Last name: [ ]

2. (Ask if not obvious) Are you male or female?

o Male

o Female

3. In what year were you born?

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

o Yes

o No

5. What is your race? Please select one or more. White, Black or African American, American Indian or Alaska Native, Asian, or Native Hawaiian or other Pacific Islander?

(Allow up to 3 answers)

[] White

[] Black or African American

[] American Indian or Alaska Native

[] Asian

[] Native Hawaiian or other Pacific Islander

6. What is the highest grade of school you have completed, or the highest degree you have received?

(do not read categories to respondent)

• Less than high school

• Completed high school

• Some college, no degree

• Associate’s degree (AA/AS)

• Bachelor’s Degree (BA/BS)

• Post-Bachelor's degree  (For example MA, MS, Ph.D, JD, etc.)

8. In what city, state, and ZIP code do you currently live?

8. How many people age 18 or older currently live in your household, INCLUDING yourself?

[ ]

11. Do you speak a language other than English at home?

o Yes (ask follow-up question)

o No (skip to next question)

1. What language or languages do you speak at home? Please select one or more.

[ ] Spanish

[ ] Chinese

[ ] Korean

[ ] Vietnamese

[ ] Arabic

[ ] Russian

[ ] Other - Specify [ ]

11. Do you own a cell phone?

o Yes (ask follow-up question)

o No (skip to next question)

1. Some cell phones are called “smartphones” because of certain features they have. Is your cell phone a smartphone, such as an iPhone, Android, Blackberry or Windows phone, or are you not sure?

11. Do you own a desktop or laptop computer, or both?

o Desktop computer

o Laptop computer

o Both desktop and laptop computer

o Neither

11. Do you own a tablet computer such as an iPad, Samsung Galaxy Tab, Google Nexus, or Kindle Fire?

o Yes

o No

11. Do you have at least one year of Internet experience?

o Yes (ask follow-up question)

o No (skip to next question)

1. How often do you use the Internet either on a computer or on a mobile device like a smartphone or tablet?...Several times a day, about once a day, a few times a week, a few times a month, or a few times a year?

Several times a day

About once a day

A few times a week

A few times a month

A few times a year

Not at all [do not read to respondent]

2. Name two things you do on the Internet besides e-mail.

Internet Activity #1:

Research

Social media/communication (Facebook, Twitter, Craigslist)

Shopping

Banking or paying bills online

Music / movies / videos

Gaming

News

Travel (directions/reservations)

Employment

Other

Internet Activity #2:

Research

Social media/communication (Facebook, Twitter, Craigslist)

Shopping

Banking or paying bills online

Music / movies / videos

Gaming

News

Travel (directions/reservations)

Employment

Other

17. Have you participated in any research studies with the U.S. Census Bureau?

o Yes

o No

18. Would you be willing to come to our office in Suitland, Maryland, to participate in a research study?

o Yes

o No

18. What is your daytime telephone number?

[Probe for all 3 phone numbers]

Mobile ([ ]) [ ] – [ ]

Home (if not mobile) ([ ]) [ ] – [ ]

Work (if any) ([ ]) [ ] – [ ] EXT.[ ]

18. What is the e-mail address we should use when sending directions to our office, should you qualify for a study?

18. Is your household’s annual income …

o Less than $15,000?

o $15,000 to $25,000?

o $25,000 to$50,000?

o $50,000 to $100,000?

o More than $100,000?

Section 2: Civic Engagement and Volunteerism Additional Screener Questions

1. Do you live in a neighborhood?

   1. Yes

   2. No

2. About how many other houses would you say are in your neighborhood?

________ Number of Houses

3. Do you live in an urban, suburban, or rural area?

   1. Urban

   2. Suburban

   3. Rural

4. Thinking about the past year, have you been involved in any of the following types of groups or organizations?

1. Religious groups or organizations?

   • Yes

   • No

2. Schools, such as through a PTA or PTO?

   • Yes

   • No

3. A union or professional association?

   • Yes

   • No

4. Charitable or other not-for-profit organizations?

   • Yes

   • No

5. Sports leagues, as either a player or a coach?

   • Yes

   • No

5. Thinking about the past year, have you done any volunteer activities through or for an organization, such as a school, children’s organization, or neighborhood or religious organization?

1. Yes

2. No

6. Thinking about the past year, how often would you say you donate money or other goods to charity?

1. Once a week or more frequently

2. A few times a month

3. Once a month

4. Once or a few times a year

7. Do you live with either a spouse , unmarried partner, boyfriend, or girlfriend?

   1. Yes – GO TO 8a

   2. No – GO TO 8b

8a. [IF Q7 = YES] How many OTHER people who are age 18 or older and are related to you currently live with you?

3. 0

4. 1

5. 2

6. 3

7. 4 or more

8b. [IF Q7= NO] How many people who are age 18 or older and are related to you currently live with you?

1. 0

2. 1

3. 2

4. 3

5. 4 or more

8c. [IF Q7=YES or (Q8a = 1 or more) or (Q8b = 1 or more)] We would like to interview several RELATED adults from the same household. What are the names and contact information of the other RELATED adults in your household, including an unmarried partner, boyfriend, or girlfriend, who might also be willing to participate in this survey? Phone number and/or email address would be most helpful.

1. First and Last Name: ____________________

Phone number: _______________________

Email address: ________________________

2. First and Last Name: ____________________

Phone number: ________________________

Email address: ________________________

3. First and Last Name: ____________________

Phone number: ________________________

Email address: ________________________

9a. How many people who are age 18 or older and who are NOT related to you currently live with you? Do not include an unmarried partner, boyfriend, or girlfriend.

1. 0

2. 1

3. 2

4. 3

5. 4 or more

9b. [IF 9a = 1 or more] We would like to interview several UNRELATED adults from the same household. What are the names and contact information of the other UNRELATED adults in your household who might also be willing to participate in this survey? Phone number and/or email address would be most helpful.

1. First and Last Name: ____________________

Phone number: _______________________

Email address: ________________________

2. First and Last Name: ____________________

Phone number: ________________________

Email address: ________________________

3. First and Last Name: ____________________

Phone number: ________________________

Email address: ________________________