Questionnaire Text

Questionnaire form view entire document: text image

14.

a) Does this person speak a language other than English at home?

[ ] Yes
[ ] No -> SKIP to question 15a

b) What is this language?

______________________________

For example: Korean, Italian, Spanish, Vietnamese

Questionnaire instructions view entire document: text image

14b. If this person speaks more than one non-English language and cannot determine which is spoken more often, report the one the person first learned to speak.