Survey Text

1979 1974 1969 1964
1978 1973 1968 1963
1977 1972 1967
1976 1971 1966
1975 1970 1965
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1979
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1978
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Hand Card R
CARD R
1. Alaskan Native or American Indian
2. Asian or Pacific Islander
3. Black
4. White
5. Another group not listed -- Please specify

Mark box or ask:
11a. Please give me the number of the group or groups which describes --'s racial background.
Circle all that apply.

[] Under 17 (NP)
[]1
[] 2
[] 3
[] 4
[] 5 (Specify) ____

If multiple entries ask:
b. Which of those groups; that is, (entries in 11a) would you say BEST describes --'s racial background?

[] 1
[] 2
[] 3
[] 4
[] 5 (Specify) ____

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1977
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3. What is --'s date of birth? (Enter date and Age and circle Race and Sex)

AGE ____
RACE ____
1 [] W
2 [] B
3 [] OT
SEX
1 [] M
2 [] F
Month ____
Date ____
Year ____

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1976
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3. What is --'s date of birth? (Enter date and Age and circle Race and Sex)

AGE ____
RACE ____
1 [] W
2 [] B
3 [] OT
SEX
1 [] M
2 [] F
Month ____
Date ____
Year ____

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1975
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3. What is --'s date of birth? (Enter date and Age and circle Race and Sex)

AGE ____
RACE ____
1 [] W
2 [] B
3 [] OT
SEX
1 [] M
2 [] F
Month ____
Date ____
Year ____

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1974
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3. What is --'s date of birth? (Enter date and Age and circle Race and Sex)

AGE ____
RACE ____
1 [] W
2 [] B
3 [] OT
SEX
1 [] M
2 [] F
Month ____
Date ____
Year ____

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1973
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3. How old was -- on his last birthday? (Enter Age and circle Race and Sex)

AGE ____
RACE
1 [] W
2 [] N
3 [] OT
SEX
1 [] M
2 [] F
C

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1972
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3. How old was -- on his last birthday? (Enter Age and circle Race and Sex)

AGE ____
RACE
1 [] W
2 [] N
3 [] OT
SEX
1 [] M
2 [] F
C

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1971
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3. How old was -- on his last birthday? (Enter Age and circle Race and Sex)

AGE ____
RACE
1 [] W
2 [] N
3 [] OT
SEX
1 [] M
2 [] F
C

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1970
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3. How old was -- on his last birthday? (Enter Age and circle Race and Sex)

AGE ____
RACE
1 [] W
2 [] N
3 [] OT
SEX
1 [] M
2 [] F
C

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1969
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3. How old was -- on his last birthday? (Enter Age and circle Race and Sex)

AGE ____
RACE
1 [] W
2 [] N
3 [] OT
SEX
1 [] M
2 [] F
C

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1968
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3. How old was --on his last birthday?
Also mark Race and sex

Age ____
Race
0[] W
1[] N
2[] OT
Sex
0[] M
1[] F

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1967
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3. How old was --on his last birthday?
Also mark Race and sex

Age ____
Race
0[] W
1[] N
2[] OT
Sex
0[] M
1[] F

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1966

No questionnaire text is available for this sample.


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1965

No questionnaire text is available for this sample.


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1964

No questionnaire text is available for this sample.


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1963

No questionnaire text is available for this sample.