Calling demograph sheet
Today's DATE:
Participant's ID#:
Participant's first name:
Phone number:
Person who is answering these questions:
What is your date of birth? Month____ Day____ Year____
What is your current marital status?
_____Married, date__________ _____Divorced, date_____________
_____Engaged to be married _____Separated, date____________
_____Living with partner _____Other
_____Single (Please specify____________)
Do you have any children? ___yes ___no
If yes, how many biological children do you have? ______#girls (Age of girl(s): ___, ___)
______#boys (Age of boy(s): ___,___)
If yes, how many step children do you have? ______#girls (Age of girl(s): ___, ___)
______#boys (Age of boy(s): ___,___)
What is the last year of school you have completed? (CHECK ONE)
_____9th grade
_____10th
_____11th
_____12th
_____GED
_____1 year of post-high school vocational training, in what__________________________
_____2 years of post-high school vocational training, in what_________________________
_____1 year of college
_____2 years of college
_____2 Year College Graduate (for example, Associates Degree)
_____Other _______________
Probe: Have you had any kind of post high school vocational training?____Yes _____No
If so, what_______________
If indicate any college, ask these questions, otherwise skip to work
Are you currently in college____Yes _____No
If attended some college, where did you attend? _____________ (now,skip to work section)
If in college now, where are you attending ____________________
If in college, have you decided on a college major?____Yes _____No
What is your college major? ___________________ (if double major, list both)
What other majors have you considered? ___________________
NOW, SKIP TO MILITARY QUESTIONS
Ask these ONLY If participant is not currently in college, JOB INFORMATION
What is your present work situation? (CHECK ALL THAT APPLY)
_____ Employed by others; part-time
_____ Employed by others; full-time
_____ Self-employed owner of own business or service, or professional practice
_____ Temporarily laid off
_____ Unemployed but looking for work
_____ Unemployed but NOT looking for work
_____ On long-term sick leave
_____ On maternity leave
_____ On parental leave
_____ Permanently disabled
_____ Full-time homemaker
_____ Working, not for money
_____ Other (If other, please explain:__________________________________________)
(If not in college, Currently,) what is your MAIN occupation or job? (Please be specific, for example, if you are a secretary, also indicate the type of business; if you are in retail, indicate what you sell; if you work in child care, indicate the age group of the children you are responsible for, etc.)
________________________________________________________________________
_________________________________________________________________________
How many jobs have you had since leaving school? _____________
Military
Are you currently serving in any branch of the Armed Services or in ROTC?
_______ Yes (SPECIFY BRANCH:_______________________)
_______ No
Have you ever served in any branch of the Armed Services or in a ROTC-like program?
_______ Yes (SPECIFY BRANCH:_______________________)
_______ No
Have you had any problems with the law? ____Yes _____No
Thank Participant, emphasize again that we do hope they will fill out the surveys, and that we will send a $20 appreciation check when we receive the surveys in our office.
When does participant believe they will send in the survey? __________________________________
Addtional comments:
In the MSALT Log-in book, under "date rec'd and list books, " write in small letters at top of box: date, P
File these sheets in the "demographics to be entered on the data base" folder in room 5211.
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