Questionnaire Text

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6. What is Person X's race? Mark (X) one or more boxes.
[ ] White
[ ] Black or African Am.
[ ] American Indian or Alaska Native -- Print name of enrolled or principal tribe. --> __________________
[ ] Asian Indian
[ ] Japanese
[ ] Chinese
[ ] Korean
[ ] Filipino
[ ] Vietnamese
[ ] Other Asian -- Print race, for example, Hmong, Laotian, Thai, Pakistani, Cambodian, and so on._________________________
[ ] Native Hawaiian
[ ] Guamanian or Chamorro
[ ] Samoan
[ ] Other Pacific Islander -- Print race, for example, Fijian, Tongan, and so on.
[ ] Some other race -- Print race. --> ____________________________________________________