| 1. MALE | 2. FEMALE |
| 1. | HISPANIC / LATIN AMERICAN |
| 2. | BLACK |
| 3. | ASIAN AMERICAN / PACIFIC ISLANDER |
| 4. | NATIVE AMERICAN |
| 5. | EUROPEAN AMERICAN / WHITE NON-HISPANIC |
| 6. | OTHER (SPECIFY) _______________________ |
| 1. | NONE | 6. | METHODIST | 11. | OTHER CHRISTIAN |
| 2. | BAPTIST | 7. | LDS | 12. | OTHER (SPECIFY) ____________ |
| 3. | EPISCOPALIAN | 8. | PRESBYTERIAN |
||
| 4. | JEWISH | 9. | ROMAN CATHOLIC |
||
| 5. | LUTHERAN | 10. | UNITED CH CHRIST (CONGREG.) |
| FULL _________ |
| HALF _________ |
| STEP _________ |
| FULL _________ |
| HALF _________ |
| STEP _________ |
| 1. POOR | 2. WORKING/LOWER MIDDLE | 3. MIDDLE | 4. UPPER MIDDLE | 5. WEALTHY |
| 1. NEVER MARRIED | 2. DIVORCED | 3. SEPARATED | 4. WIDOWED | 5. CURRENTLY MARRIED |
| 1. GRADE SCHOOL | 5. SOME COLLEGE | 8. MASTER'S DEGREE |
| 2. SOME HIGH SCHOOL | 6. BACHELOR'S DEGREE | 9. SOME POSTMASTER'S WORK |
| 3. HIGH SCHOOL GRAD | 7. SOME GRADUATE WORK | 10. PROFESSIONAL (MD, JD, DDS, DVM) |
| 4. AA DEG/TECH CERT./LIC.TRADE | 11. PHD |
| 1. GRADE SCHOOL | 5. SOME COLLEGE | 8. MASTER'S DEGREE |
| 2. SOME HIGH SCHOOL | 6. BACHELOR'S DEGREE | 9. SOME POSTMASTER'S WORK |
| 3. HIGH SCHOOL GRAD | 7. SOME GRADUATE WORK | 10. PROFESSIONAL (MD, JD, DDS, DVM) |
| 4. AA DEG/TECH CERT./LIC.TRADE | 11. PHD |
| 1. | DECEASED |
| 2. | NO INCOME |
| 3. | LESS THAN $15,000 |
| 4. | $15,000 OR MORE BUT LESS THAN $30,000 |
| 5. | $30,000 OR MORE BUT LESS THAN $45,000 |
| 6 | $45,000 OR MORE BUT LESS THAN $75,000 |
| 7. | MORE THAN $75,000 |
| 1. | DECEASED |
| 2. | NO INCOME |
| 3. | LESS THAN $15,000 |
| 4. | $15,000 OR MORE BUT LESS THAN $30,000 |
| 5. | $30,000 OR MORE BUT LESS THAN $45,000 |
| 6 | $45,000 OR MORE BUT LESS THAN $75,000 |
| 7. | MORE THAN $75,000 |
| 1. | NEVER OR ALMOST NEVER |
| 2. | RARELY |
| 3. | SOMETIMES |
| 4. | FREQUENTLY |
| 5. | ALWAYS OR ALMOST ALWAYS |
| 1. | NEVER OR ALMOST NEVER |
| 2. | RARELY |
| 3. | SOMETIMES |
| 4. | FREQUENTLY |
| 5. | ALWAYS OR ALMOST ALWAYS |
| 1. | Fs |
| 2. | Ds |
| 3. | Cs |
| 4. | Bs |
| 5. | As |
| 1. | Fs |
| 2. | Ds |
| 3. | Cs |
| 4. | Bs |
| 5. | As |
| 1. | YES |
| 2. | NO |
| 1. | NOT GREATLY EMPHASIZED |
| 2. | CONSIDERED LESS IMPORTANT THAN OTHER THINGS |
| 3. | SOMEWHAT IMPORTANT |
| 4. | VERY IMPORTANT |
| 5. | EXTREMELY IMPORTANT |
| 1. | Fs |
| 2. | Ds |
| 3. | Cs |
| 4. | Bs |
| 5. | As |
| 1. | Fs |
| 2. | Ds |
| 3. | Cs |
| 4. | Bs |
| 5. | As |
| 1. | NOT GREATLY EMPHASIZED |
| 2. | CONSIDERED LESS IMPORTANT THAN OTHER THINGS |
| 3. | SOMEWHAT IMPORTANT |
| 4. | VERY IMPORTANT |
| 5. | EXTREMELY IMPORTANT |
| 1. | FRESHMAN |
| 2. | SOPHOMORE |
| 3. | JUNIOR |
| 4. | SENIOR |
| 5. | GRAD |
| SAT -- MATH ________ | SAT--VERBAL ________ | ACT ________ |
| 1. | ________% | YOUR PARENTS |
| 2. | ________% | LOANS |
| 3. | ________% | SCHOLARSHIPS/ GRANTS |
| 4. | ________% | YOUR EARNINGS |
| 5. | ________% | OTHER |
| 1. | ________% | YOUR PARENTS |
| 2. | ________% | LOANS |
| 3. | ________% | SCHOLARSHIPS/ GRANTS |
| 4. | ________% | YOUR EARNINGS |
| 5. | ________% | OTHER |
| 1. | _____ KIND | 7. | _____ HEALTHY | 13. | _____ SEXY |
| 2. | _____ GOOD MOTHER/FATHER | 8. | _____ WELL EDUCATED | 14. | _____ FAITHFUL |
| 3. | _____ INTELLIGENT | 9. | _____ ROMANTIC | 15. | _____ HONEST |
| 4. | _____ PHYSICALLY ATTRACTIVE | 10. | _____ PHYSICALLY STRONG | 16. | _____ ADVENTUROUS |
| 5. | _____ SIMILAR BACKGROUND | 11. | _____ SUPPORTIVE | 17. | _____ OUTGOING |
| 6. | _____ WEALTH OR INCOME | 12. | _____ EMOTIONALLY STABLE | 18. | _____ SENSE OF HUMOR |
| 1. | _____ KIND | 7. | _____ GOOD WITH KIDS | 13. | _____ PROMISCUOUS |
| 2. | _____ GOOD MATE | 8. | _____ EARNING PROSPECTS | 14. | _____ FAITHFUL |
| 3. | _____ INTELLIGENT | 9. | _____ ROMANTIC | 15. | _____ HONEST |
| 4. | _____ PHYSICALLY ATTRACTIVE | 10. | _____ PHYSICALLY STRONG | 16. | _____ CREATIVE |
| 5. | _____ UNUSUAL/UNIQUE | 11. | _____ SUPPORTIVE | 17. | _____ LIKABLE |
| 6. | _____ HEALTHY/ENERGETIC | 12. | _____ EMOTIONALLY STABLE | 18. | _____ SENSE OF HUMOR |
| 1. | NEVER MARRIED, NOT LIVING W/ A MATE |
| 2. | NEVER MARRIED, LIVING W/ A MATE |
| 3. | MARRIED AND LIVING WITH SPOUSE |
| 4. | SEPARATED, WIDOWED OR DIVORCED, NOT LIVING W/ A MATE |
| 5. | SEPARATED, WIDOWED OR DIVORCED, LIVING W/ A MATE |
| 1. | AM CURRENTLY MARRIED OR ENGAGED |
| 2. | LIKELY TO BE MARRIED WITHIN 5 YEARS |
| 3. | LIKELY TO BE MARRIED WITHIN 10 YEARS |
| 4. | MAY GET MARRIED, BUT UNCERTAIN WHEN |
| 5. | WILL PROBABLY NOT MARRY |
| 1. | MORE THAN 5 YEARS YOUNGER |
| 2. | SLIGHTLY YOUNGER |
| 3. | ABOUT THE SAME AGE AS YOURSELF |
| 4. | SLIGHTLY OLDER |
| 5 . | MORE THAN 5 YEARS OLDER |
| 1. | HIGH SCHOOL | 2. | ASSOCIATE | 3. | BACHELORS DEGREE |
| 4. | MASTERS | 5. | PH.D. | 6. | PROFESSIONAL (MD, JD,DDS, DVM) |
IF YOU HAVE HAD CHILDREN, PLEASE LIST THEIR AGES ___________________
| NONE | ONE | TWO | THREE | FOUR | FIVE | SIX | MORE THAN SIX |
| BEFORE 12 | 12 | 13 | 14 | 15 | 16 | AFTER 16 |
MISCELLANEOUS QUESTIONS FROM PAST SURVEYS:
| 1. YES | 2. NO | 3. CAN'T REMEMBER |
| 1. YES | 2. NO | 3. CAN'T REMEMBER |
| 1. | NOT GREATLY EMPHASIZED |
| 2. | CONSIDERED LESS IMPORTANT THAN OTHER THINGS |
| 3. | SOMEWHAT IMPORTANT |
| 4. | VERY IMPORTANT |
| 5. | EXTREMELY IMPORTANT |
| 1. YES | 2. NO |
| 1. TERRIBLE | 2. POOR | 3. AVERAGE | 4. GOOD | 5. EXCELLENT |
| 1. YES | 2. NO |
| 1. | _____ | STUDYING |
| 2. | _____ | READING FICTION |
| 3. | _____ | EXERCISING OR PLAYING A SPORT (What kind of sport? ____________________) |
| 4. | _____ | WATCHING TELEVISION |
| 5. | _____ | SOCIALIZING WITH FRIENDS |
| 6. | _____ | COMMUNITY SERVICE ACTIVITIES |
| 7. | _____ | WORKING IN A PAYING JOB |
| 1. YES | 2. NO |