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Gender?
Male Female
 
 

Age
 
13-19
 
20-30
 
30-40
 
50+
 
 
Choose all the apply. If other please specify
race
Black White(non Hispanic) Hispanic Asian Other  
 
 

Where you born in the United States?
 
Yes
 
No
 
 
 
If No Please Specify
 
 
 

Have you ever visited or returned to your "native land"?
yes no
 
 
Pick all that apply.
How many people live in your household?
 
1-2
 
3-5
 
6+
 
Mother
 
Father
 
Sister
 
Brother
 
Uncle
 
Aunt
 
Grandmother
 
Grandfather
 
Your Child
 
Other
 

 
 
Below is a lis of statements. Indicate how you feel about each one.
Strongly Disagree Disadree Neutral Agree Strongly Agree
Financial security is very important to me.
I spend my money rather then save my money.
I rebel against the way i was brought up.
My views are more conservative then liberal.
Women can and should work outside the home(if they want to) even if they have small children.
Family is the most important thing.
 
 
Below is a list of activities choose how often you do each.
Frequently Occasionally Seldom Never
Watch TV
Play Sports (Basketball Soccer baseball etc.)
Run/Jog/Walk
Dancing
Going out to eat
Surf the internet
Study for school or work
read for pleasure
 
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