Background Questionnaire
Please answer all of the following questions as they describe you.
| 1. Gender (circle one):
Female Male Other: _________ |
8. Please report an estimate of your household’s combined annual income in thousands of dollars:
_____________ |
| 2. Age ______ | 9. Please circle one of the following to indicate your primary ethnic identity:
A. African American B. Asian American C. White, non-Hispanic D. White, Hispanic E. Middle Eastern F. Other: __________________ |
| 3. Religion (circle ONE):
A. Christian/Catholic B. Christian/Non-Catholic C. Jewish D. Muslim E. Other _____________ |
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| 4. What kind of area were you raised in?
A. rural B. small town C. suburban D. urban E. Other ________ |
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| 5. Political orientation:
A. very conservative B. conservative C. moderate D. liberal E. very liberal |
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| 6. Sexual orientation:
A. primarily heterosexual B. primarily bisexual C. primarily homosexual D. Other _________________ |
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| 7. Marital status of parents:
A. Married B. Separated C. Divorced D. Never married E. Other ________ |
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