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10 Cards in this Set

  • Front
  • Back
Religious affiliation?
___Protestant Christian
___Roman Catholic
___Evangelical Christian
___Other _______________
Question 1
____ 25-32
____ 33-40
____ 41-50
____ 51-64
Question 2
___ male
___ female
Question 3
If you have children are they:
____ minors at home
____ adults at home
____away from home
Question 4
___American Indian or Alaska Native
___Hawaiian or Other Pacific Islander
___Asian or Asian American
___Black or African American
___Hispanic or Latino
___Non-Hispanic White
Question 5
Marital status:
___ Married
___ Divorced
___ Widowed
___ Separated
___ Never been married
____A member of an unmarried couple
Question 6
Employment status:
___ Employed for wages Part time
____ Employed for wages Full time
____ Self-employed
____Out of work for more than 1 year
____ Out of work for less than 1 year
____ A homemaker
____A student
____ Retired
____ Unable to work
Question 7
Is your house, apartment, or mobile home -
___ Owned by you or someone in your household with a mortgage or loan?
___Owned by you or someone in this household free and clear (without a mortgage or loan)?
___ Rented for cash rent?
___ Occupied without payment of cash rent?
Question 8
What is the highest degree or level of school you have completed? If currently enrolled, mark the previous grade or highest degree received.
____ No schooling completed
____ Elem - 11th grade
____12th grade, no diploma
____ High school graduate - high school diploma or the equivalent
____ Some college credit, but less than 1 year
____1 or more years of college, no degree
____ Associates Degree
____ Other:_____________________
Question 9
Political Affiliation:
____ Republican
____ Democrat
____ Other:______________
Question 10