Questionnaire Text

Questionnaire form view entire document:  text  image

6. What is this person's race? Mark (X) one or more races to indicate what this person considers himself/herself to be

[ ] White
[ ] Black, African Am., or Negro
[ ] American Indian or Alaska Native -- Print name of enrolled or principal tribe --> ________________________________________
[ ] Asian Indian
[ ] Chinese
[ ] Filipino
[ ] Japanese
[ ] Korean
[ ] Vietnamese
[ ] Other Asian - Print race --> ____________________
[ ] Native Hawaiian
[ ] Guamanian or Chamorro
[ ] Samoan
[ ] Other Pacific Islander
[ ] Some other race - Print race below --> ____________________

Questionnaire instructions view entire document:  text  image

6.Mark one or more categories to indicate what each person considers himself or herself to be.

If you mark the "American Indian or Alaska Native" box, also print the name of the tribe(s) in which the person is enrolled. If the person is not enrolled in a tribe, print the name of the principal tribe.

If you mark the "Other Asian" or the "Other Pacific Islander" box, print the name of the specific race(s) or group(s) in the space provided.

The category Other Asian includes persons who identify themselves as Burmese, Hmong, Indonesian, Laotian, Pakistani, Thai, Cambodian, Sri Lankan, and so on.

The category Other Pacific Islander includes persons who identify themselves as Fijian, Tongan, Polynesian, Tahitian, and so on.

If you mark the "Some other race" box, print the race(s) or group(s) in the space provided.

This question should be answered for ALL persons, regardless of citizenship status.