a. Your sex: 1. _____ Female 2. _____ Male b. Your age: 1. _____ Younger than 20

Question

a. Your sex:

1. _____ Female

2. _____ Male

b. Your age:

1. _____ Younger than 20

2. _____ 20–29

3. _____ 30–39

4. _____ 40–49

5. _____ 50–59

6. _____ 60–69

7. _____ 70 or older

c. How many people are in your immediate family? ___________

d. Specify the highest level of education achieved by your mother:

1. _____ None

2. _____ Elementary school

3. _____ Some high school

4. _____ Graduated high school

5. _____ Some college

6. _____ Graduated college

7. _____ Graduate/professional school

e. Your annual income from all sources: ___________ (specify)

f.Your religious preference:

1. _____ Protestant

2. _____ Catholic

3. _____ Jewish

4. _____ Other ___________ (specify)

g. The social class to which your parents belong:

1. _____ Upper

2. _____ Upper-middle

3. _____ Middle-middle

4. _____ Lower-middle

5. _____ Lower

h. In which of the following regions do your parents presently live?

1. _____ Northeast

2. _____ South

3. _____ Midwest

4. _____ West

5. _____ Other ___________ (specify)

i. Indicate your political orientation by placing an X in the appropriate space: LIBERAL___:___:___:___:___:Conservative

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Explanation / Answer

Please find the duely filled form:

a. Your sex:
1. _____ Female
2. _____ Male ( Yes)
b. Your age:
1. _____ Younger than 20
2. _____ 20–29
3. _____ 30–39
4. _____ 40–49 ( Yes)
5. _____ 50–59
6. _____ 60–69
7. _____ 70 or older
c. How many people are in your immediate family? ___________ 2
d. Specify the highest level of education achieved by your mother:
1. _____ None
2. _____ Elementary school
3. _____ Some high school
4. _____ Graduated high school
5. _____ Some college
6. _____ Graduated college
7. _____ Graduate/professional school ( Yes)
e. Your annual income from all sources: $200,000 (specify)
f.Your religious preference:
1. _____ Protestant
2. _____ Catholic ( Yes)
3. _____ Jewish
4. _____ Other ___________ (specify)
g. The social class to which your parents belong:
1. _____ Upper
2. _____ Upper-middle ( Yes)
3. _____ Middle-middle
4. _____ Lower-middle
5. _____ Lower
h. In which of the following regions do your parents presently live?
1. _____ Northeast
2. _____ South ( Yes)
3. _____ Midwest
4. _____ West
5. _____ Other ___________ (specify)
i. Indicate your political orientation by placing an X in the appropriate space: LIBERAL___:X:___:___:___:Conservative
1 2 3 4 5

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