demographicform

Demographic information form

date:

interviewee code:

Age:

Sex:

Race:

Enrolled in college?: yes no

Socio-economic bracket (of parents or of self):

a. less than 10, 000

f. 50,000-74,999

b. 10,000-14,999

g. 75,000-99,999

c. 15,000-24,999

h. 100,000-149,999

d. 25,000-34,999

i. 150,000-199,999

e. 35,000-49,999

j. more than 200,000

Political affiliation:

Democrat
Republican

Indepdent

none

other: ___________

a. less than 10, 000	f. 50,000-74,999
b. 10,000-14,999	g. 75,000-99,999
c. 15,000-24,999	h. 100,000-149,999
d. 25,000-34,999	i. 150,000-199,999
e. 35,000-49,999	j. more than 200,000