Appendix D: Sample Demographic Analysis

Please—no names!

Directions: Circle the appropriate answers.

Enrollment:   Full-time student       Part-time student

Type:  Transfer/General Studies   Professional-Technical   Dual Credit

Major:  General Studies  Business    Education    Communication

Pre-Medical-Related  Psychology     Other:______________

1. Age:
   1. 19 and younger
   2. 20–24
   3. 25–39
   4. 40 and older
2. Sex:
   1. Female
   2. Male
3. Marital status:
   1. single
   2. committed relationship
   3. married
   4. separated
   5. divorced
   6. widowed
4. Number of Children:
   1. no children
   2. one child
   3. more than one child
5. Religious preference:
   1. Atheist/Agnostic
   2. Christian
   3. Jewish
   4. Muslim
   5. Buddhist
   6. Other:___________
6. Political Affiliation:
   1. Democrat
   2. Republican
   3. Independent
   4. Supporter of a third party (Libertarian, Green, Socialist, etc.)
   5. Non-Political
7. Personal/family income:
   1. $10,000 or below
   2. $10,001–15,000
   3. $15,001–30,000
   4. $30,001–60,000
   5. over $60,000
8. I am from:
   1. the country
   2. a small town
   3. a medium-sized town
   4. a city
   5. a big city
9. My financial support mainly comes from (circle all that apply):
   1. parents, spouse, or other family member
   2. full-time job
   3. part-time or summer job
   4. savings
   5. scholarships/grants/loans
10. I currently live:
    1. at home with parents/family
    2. in a rental room/apartment/house
    3. in the residence hall
    4. in a home I own
    5. Other:_____________