Demographic Questionnaire - Stanford Study of Writing

Demographic Questionnaire I have signed the Consent Form agreeing to participate in the study of this course, "Multimedia Magazines: Communication for Change," that has been approved by the University Panel on Human Subjects in Non-Medical Research. I understand that my responses to this questionnaire are voluntary and that I can choose not to answer certain questions. Furthermore, I understand that I will not be identified by name in any research or publications resulting from this study.

First Name: ________________________ Last Name: ________________________

Signature: ___________________________________ Date: ___________

Campus Contact Information Email: _______________________ Phone: ___________________ Address: ________________________________________________________ City:_________________________ State: _________ Zip: ______________

Home Address Information Address: ________________________________________________________ City:_________________________ State: _________ Zip: ______________

Nationality/Ethnicity US citizen (yes or no): ____________ Country of Birth: ________________

Self Description (please choose any or all that apply):

____ American Indian ____ Asian-American/Oriental/Pacific Islander ____ Asian East Indian ____ Black/African-American ____ Mexican-America/Chicano ____ Puerto-Rican ____ Other Hispanic ____ White/Caucasian ____ Other

Language History

First Language: ____________________

Home Language: ___________________

Other Languages (s): ________________

Education History

High School: ___________________

High school Location: ___________________

High School GPA: ___________________

Verbal SAT: ___________________

Math SAT: ___________________

Writing AP: ___________________

Literature AP: ___________________

International Baccalaureate Exam: ___________________

Parents' Education Father's education (degree): ____________ Mother's education (degree): ___________

Father's work: ________________ Mother's work: ________________

Use of Technology (please choose any or all that apply) ____ I own a computer ____ My family owns a computer ____ I had access to computers in high school ____ I am taking (or have taken) one or more classes in a computer classroom ____ I use the Internet regularly ____ I know how to create a web page ____ I use a word processor to complete most of my written assignments ____ I use assistive technologies for my writing/reading

Freshman year/fall quarter classes at Stanford (please list)

Intended Area of Study Freshman Year: _______________________

Are you involved in any extracurricular activities that allow you to use your writing abilities? (yes or no) __________ If "yes" please describe these activities:

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