Form 3045-0163 Race and Ethnicity Pilot Study Question

Question 

 

What is your race or ethnicity? Select all that apply.  

• White 

• Hispanic or Latino 

• Black or African American 

• Asian 

• American Indian or Alaska Native 

• Middle Eastern or North African 

• Native Hawaiian  

 

Consent form language  

 

The Census is interested in revising the race and ethnicity question for future surveys. We have an opportunity to be part of testing a new question which may be asked of every resident in the United States for years to come. Please answer the one question which will take one minute or less. 

This is voluntary and confidential. The information that is provided to Census will be aggregated and no single individual or program will be identified. 

 

If you have any questions, please contact Kyle Brees, Research Analyst, AmeriCorps Office of Research and Evaluation, [email protected].