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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