FORM NSCG-1
(3-17-97) OMB No.: 3145-0141
Approval Expires: 4/30/99
1997 National Survey of College Graduates
This information is solicited under the authority of the National Science Foundation Act of 1950, as amended. Your report to the Census Bureau is confidential by law (Title 13, U.S. Code and the Federal Privacy Act of 1974). All information you provide will be treated as confidential and used only for research or statistical purposes by the survey sponsors, their contractors, and collaborating researchers for the purpose of analyzing data and preparing scientific reports and articles. Any information publicly released (such as statistical summaries) will be in a form that does not personally identify you. Your response is voluntary and failure to provide some or all of the requested information will not in any way adversely affect you. Actual time to complete the questionnaire may vary depending on your circumstances. On the average, it will take about 25 minutes to complete the questionnaire. If you have any comments on the time required for this survey, please send them to Herman Fleming, Division of Contracts, Policy and Oversight, National Science Foundation, 4201 Wilson Boulevard, Arlington, VA 22230. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. The OMB number for this project is 3145-0141.
Conducted by:
U.S. Department of Commerce BUREAU OF THE CENSUS for the National Science Foundation Arlington, VA
Thank you for taking the time to complete this questionnaire. Directions for filling it out are provided with each question. Because not all questions will apply to everyone, you may be asked to skip certain questions.
- In order to get comparable data, we will be asking you to refer to the week of April 15, 1997 (e.g., April 13-April 19, 1997) when answering most questions
- Follow all "SKIP" instructions AFTER marking a box. If no
- "SKIP" instruction is provided, you should continue to the NEXT question
- C Either a pen or pencil may be used
- C When answering questions that require marking a box, please use an "X"
- C If you need to change an answer, please make sure that your old answer is either completely erased or clearly crossed out
Thanks again for your help, we really appreciate it.
PART A - Employment Status During the Reference Week of April 13-19, 1997
A1.
Were you working for pay (or profit) during the week of April 15, 1997? This includes being self-employed or temporarily absent from a job (e.g., illness, vacation or parental leave), even if unpaid.
STUDENTS: Do NOT count financial aid awards with no work requirement
STUDENTS: Do NOT count financial aid awards with no work requirement
1 [ ] Yes (SKIP to A7)
2 [ ] No
2 [ ] No
A2.
(IF NO) Did you look for work during the four weeks preceding April 15, 1997 (that is, anytime between March 19 and April 15, 1997)?
1 [ ] Yes
2 [ ] No
2 [ ] No
A3.
What were your reasons for not working during the week of April 15?
Mark (X) all that apply
Mark (X) all that apply
1 [ ] Retired, Year Retired: 19 |___|___|
2 [ ] On layoff from a job
3 [ ] Student
4 [ ] Family responsibilities
5 [ ] Chronic illness or permanent disability
6 [ ] Suitable job not available
7 [ ] Did not need or want to work
8 [ ] Other ? Specify: _______________________________
2 [ ] On layoff from a job
3 [ ] Student
4 [ ] Family responsibilities
5 [ ] Chronic illness or permanent disability
6 [ ] Suitable job not available
7 [ ] Did not need or want to work
8 [ ] Other ? Specify: _______________________________
A4.
Prior to the week of April 15, 1997, when did you last work for pay (or profit)?
0 [ ] MARK (X) THIS BOX IF NEVER WORKED FOR PAY (OR PROFIT) AND SKIP TO PART D, PAGE 11
0 [ ] MARK (X) THIS BOX IF NEVER WORKED FOR PAY (OR PROFIT) AND SKIP TO PART D, PAGE 11
LAST WORKED:
Month: |___|___| Year: 19 |___|___|
Month: |___|___| Year: 19 |___|___|
A5.
What kind of work were you doing on this last job--that is, what was your occupation? Please be as specific as possible, including any area of specialization
EXAMPLE: High school teacher ? Math
EXAMPLE: High school teacher ? Math
_____________________________________________________________
_______________________________________________________________
_______________________________________________________________
A6.
Using the JOB CODES LIST (pages 14-15), choose the code that BEST describes the work you were doing on this last job.
CODE ______ SKIP to A48, page 7
NOTE - Job codes range from 010 to 500
NOTE - Job codes range from 010 to 500
A7.
(IF WORKED DURING WEEK OF APRIL 15TH) Counting all jobs held during the week of April 15, 1997, did you USUALLY work . . .
1 [ ] A total of 35 or more hours per week (SKIP to A10, page 2)
2 [ ] Fewer than 35 hours per week
2 [ ] Fewer than 35 hours per week
A8.
(IF FEWER THAN 35 HOURS) During the week of April 15, did you want to work a full-time work week of 35 or more hours?
1 [ ] Yes
2 [ ] No
2 [ ] No
A9.
What were your reasons for working a part-time work week (i.e., less than 35 hours) during the week of April 15?
Mark (X) all that apply
Mark (X) all that apply
1 [ ] Retired or semi-retired: Year Retired: 19 ___ ___ (SKIP to A11)
2 [ ] Student (SKIP to A11)
3 [ ] Family responsibilities (SKIP to A11)
4 [ ] Chronic illness or permanent disability (SKIP to A11)
5 [ ] Suitable full-time work week job not available (SKIP to A11)
6 [ ] Did not need or want to work full-time (SKIP to A11)
7 [ ] Other ? Specify: _______________________ (SKIP to A11)
2 [ ] Student (SKIP to A11)
3 [ ] Family responsibilities (SKIP to A11)
4 [ ] Chronic illness or permanent disability (SKIP to A11)
5 [ ] Suitable full-time work week job not available (SKIP to A11)
6 [ ] Did not need or want to work full-time (SKIP to A11)
7 [ ] Other ? Specify: _______________________ (SKIP to A11)
A10.
(IF 35 OR MORE HOURS) Although you were working during the week of April 15, had you previously RETIRED from any position?
Examples of retirement include mandatory retirement, early retirement, or voluntary retirement
Examples of retirement include mandatory retirement, early retirement, or voluntary retirement
1 [ ] Yes, Year Retired: 19 |___|___|
2 [ ] No
2 [ ] No
The next several questions ask about your principal employer during the week of April 15,
A11.
Who was your principal employer during the week of April 15, 1997?
IF MORE THAN ONE JOB: Record employer for whom you worked the most hours that week
IF EMPLOYER HAD MORE THAN ONE LOCATION: Record location where you usually worked
IF MORE THAN ONE JOB: Record employer for whom you worked the most hours that week
IF EMPLOYER HAD MORE THAN ONE LOCATION: Record location where you usually worked
Employer: _____________________________
Name: ________________________________
City/Town: _____________________________
State/Foreign Country: ____________________
ZIP Code: ______________________________
Name: ________________________________
City/Town: _____________________________
State/Foreign Country: ____________________
ZIP Code: ______________________________
A12.
Thinking about your employer's main business (i.e., what your employer makes or does), under which of these categories does your employer's main business BEST fit?
IF PRINCIPAL EMPLOYER HAS MORE THAN ONE TYPE OF BUSINESS: Please answer for the type of business primarily performed at the location where you work
Mark (X) ONLY one
IF PRINCIPAL EMPLOYER HAS MORE THAN ONE TYPE OF BUSINESS: Please answer for the type of business primarily performed at the location where you work
Mark (X) ONLY one
1 [ ] Agriculture, forestry, or fishing
2 [ ] Biotechnology
3 [ ] Construction or mining
4 [ ] Education
5 [ ] Finance, insurance or real estate services
6 [ ] Health services
7 [ ] Information technology or computer services
8 [ ] All other services (e.g., social, legal, business)
9 [ ] Manufacturing
10 [ ] Public administration/government
11 [ ] Research ? Specify: ____________________________________
12 [ ] Transportation services, utilities or communications
13 [ ] Wholesale or retail trade
14 [ ] Other
2 [ ] Biotechnology
3 [ ] Construction or mining
4 [ ] Education
5 [ ] Finance, insurance or real estate services
6 [ ] Health services
7 [ ] Information technology or computer services
8 [ ] All other services (e.g., social, legal, business)
9 [ ] Manufacturing
10 [ ] Public administration/government
11 [ ] Research ? Specify: ____________________________________
12 [ ] Transportation services, utilities or communications
13 [ ] Wholesale or retail trade
14 [ ] Other
A13.
Counting all locations where this employer operates, how many people work for your principal employer? Your best estimate is fine.
Mark (X) ONLY one
Mark (X) ONLY one
1 [ ] Under 10 employees
2 [ ] 10 - 24 employees
3 [ ] 25 - 99 employees
4 [ ] 100 - 499 employees
5 [ ] 500 - 999 employees
6 [ ] 1,000 - 4,999 employees
7 [ ] 5,000 + employees
2 [ ] 10 - 24 employees
3 [ ] 25 - 99 employees
4 [ ] 100 - 499 employees
5 [ ] 500 - 999 employees
6 [ ] 1,000 - 4,999 employees
7 [ ] 5,000 + employees
A14.
Did your principal employer come into being as a new business within the past 5 years?
1 [ ] Yes
2 [ ] No
2 [ ] No
A15.
Was your principal employer during the week of April 15 . . .
IF EMPLOYER WAS A SCHOOL: Mark (X) the type of organizational charter (e.g., mark "state government" for state schools, most private schools are "private not-for-profit")
Mark (X) ONLY one
IF EMPLOYER WAS A SCHOOL: Mark (X) the type of organizational charter (e.g., mark "state government" for state schools, most private schools are "private not-for-profit")
Mark (X) ONLY one
1 [ ] A PRIVATE FOR-PROFIT company, business or individual, working for wages, salary or commissions
2 [ ] A PRIVATE NOT-FOR-PROFIT, tax-exempt, or charitable organization
3 [ ] SELF-EMPLOYED in own NOT INCORPORATED business, professional practice, or farm
4 [ ] SELF-EMPLOYED in own INCORPORATED business, professional practice, or farm
5 [ ] Local GOVERNMENT (e.g., city, county)
6 [ ] State GOVERNMENT
7 [ ] U.S. military service, active duty or Commissioned Corps (e.g., USPHS, NOAA)
8 [ ] U.S. GOVERNMENT (e.g., civilian employee)
9 [ ] Other ? Specify: __________________________
2 [ ] A PRIVATE NOT-FOR-PROFIT, tax-exempt, or charitable organization
3 [ ] SELF-EMPLOYED in own NOT INCORPORATED business, professional practice, or farm
4 [ ] SELF-EMPLOYED in own INCORPORATED business, professional practice, or farm
5 [ ] Local GOVERNMENT (e.g., city, county)
6 [ ] State GOVERNMENT
7 [ ] U.S. military service, active duty or Commissioned Corps (e.g., USPHS, NOAA)
8 [ ] U.S. GOVERNMENT (e.g., civilian employee)
9 [ ] Other ? Specify: __________________________
A16.
Was your principal employer an educational institution?
1 [ ] Yes
2 [ ] No (SKIP to A18)
2 [ ] No (SKIP to A18)
A17.
(IF EDUCATIONAL INSTITUTION) Was this educational institution a . . .
Mark (X) ONLY one
Mark (X) ONLY one
1 [ ] Preschool, elementary, or middle school or system
2 [ ] Secondary school or system
3 [ ] Two-year college, community college, technical institute
4 [ ] Four-year college or university, other than a medical school
5 [ ] Medical school (including university-affiliated hospital or medical center)
6 [ ] University-affiliated research institute
7 [ ] Something else ? Specify: ___________________________________
2 [ ] Secondary school or system
3 [ ] Two-year college, community college, technical institute
4 [ ] Four-year college or university, other than a medical school
5 [ ] Medical school (including university-affiliated hospital or medical center)
6 [ ] University-affiliated research institute
7 [ ] Something else ? Specify: ___________________________________
The next several questions ask about some alternative or temporary working relationships that people may have with their employers.
A18.
Did any of the following apply to your relationship with your principal employer during the week of April 15, 1997?
Mark (X) Yes or No for each
Mark (X) Yes or No for each
1. Self-employed working as an independent contractor, independent consultant, free lance worker or otherwise self-employed
2. Your principal employer contracted out your services to other organizations (not including temporary help or employment agencies)
3. Working through a temporary help or employment agency
4. Working on an "as needed", "seasonal" or short term basis
5. Job sharing
6. Working from home for 50 percent or more of your work time
7. Something else ? Specify: __________________________
1 [ ] Yes 2 [ ] No
2. Your principal employer contracted out your services to other organizations (not including temporary help or employment agencies)
1 [ ] Yes 2 [ ] No
3. Working through a temporary help or employment agency
1 [ ] Yes 2 [ ] No
4. Working on an "as needed", "seasonal" or short term basis
1 [ ] Yes 2 [ ] No
5. Job sharing
1 [ ] Yes 2 [ ] No
6. Working from home for 50 percent or more of your work time
1 [ ] Yes 2 [ ] No
7. Something else ? Specify: __________________________
1 [ ] Yes 2 [ ] No
A19.
Did you answer "yes" to any of the categories above?
1 [ ] Yes
2 [ ] No (SKIP to A22, page 4)
2 [ ] No (SKIP to A22, page 4)
A20.
(IF YES) What were your reasons for having an alternative or temporary work arrangement during the week of April 15?
For this study, being self-employed is considered an alternative working relationship
Mark (X) Yes or No for each
For this study, being self-employed is considered an alternative working relationship
Mark (X) Yes or No for each
1. Schedule flexibility
2. Only type of work you could find
3. Gain experience that may lead to a permanent job
4. Better pay
5. Family-related reasons (e.g., children, spouse?s job moved)
6. In school or some type of training program
7. Enjoy being your own boss
8. Employer changed your status to temporary
9. Other reason ? Specify: ______________________________________
1 [ ] Yes 2 [ ] No
2. Only type of work you could find
1 [ ] Yes 2 [ ] No
3. Gain experience that may lead to a permanent job
1 [ ] Yes 2 [ ] No
4. Better pay
1 [ ] Yes 2 [ ] No
5. Family-related reasons (e.g., children, spouse?s job moved)
1 [ ] Yes 2 [ ] No
6. In school or some type of training program
1 [ ] Yes 2 [ ] No
7. Enjoy being your own boss
1 [ ] Yes 2 [ ] No
8. Employer changed your status to temporary
1 [ ] Yes 2 [ ] No
9. Other reason ? Specify: ______________________________________
1 [ ] Yes 2 [ ] No
A21.
Which factors in A20 represent your two main reasons for holding alternative or temporary employment or being self-employed?
Enter the number of the appropriate reason from A20 above
Enter the number of the appropriate reason from A20 above
1. _____ First reason
2. _____ Second reason (Enter "0" if no second reason)
2. _____ Second reason (Enter "0" if no second reason)
A22.
If you could have any type of working relationship you wanted, would your first choice be . . .
Mark (X) ONLY one
Mark (X) ONLY one
1 [ ] A permanent job (either full-time or part-time), that is a job with no set end date
2 [ ] Being self-employed
3 [ ] Some other type of working relationship ? Specify: _______________________
2 [ ] Being self-employed
3 [ ] Some other type of working relationship ? Specify: _______________________
A23.
Concerning your principal job during the week of April 15, were any of the following benefits available to you, even if you chose not to take them?
Mark (X) Yes or No for each
Mark (X) Yes or No for each
1. Health insurance that was at least partially paid by your employer?
2. A pension plan or a retirement plan to which your employer contributed?
3. A profit-sharing plan?
4. Paid vacation, sick or personal days?
1 [ ] Yes 2 [ ] No
2. A pension plan or a retirement plan to which your employer contributed?
1 [ ] Yes 2 [ ] No
3. A profit-sharing plan?
1 [ ] Yes 2 [ ] No
4. Paid vacation, sick or personal days?
1 [ ] Yes 2 [ ] No
The next set of questions asks about your work on your principal job during the week of April 15, 1997.
A24.
What kind of work were you doing on your principal job held during the week of April 15, 1997--that is, what was your occupation?
Please be as specific as possible, including any area of specialization
EXAMPLE: High school teacher - Math
Please be as specific as possible, including any area of specialization
EXAMPLE: High school teacher - Math
____________________________________________________
____________________________________________________
____________________________________________________
A25.
Using the JOB CODES LIST (pages 14-15), choose the code that BEST describes the work you were doing on your principal job during the week of April 15.
CODE _____
Note ? Job codes range from 010 to 500
Note ? Job codes range from 010 to 500
A26.
Did you record job code "141" (manager, executive, or administrator) in A25?
1 [ ] Yes
2 [ ] No (SKIP to A28)
2 [ ] No (SKIP to A28)
A27.
(IF YES) Did your duties on this job require the technical expertise of a bachelor's degree or higher in . . .
Mark (X) Yes or No for each
Mark (X) Yes or No for each
1. Engineering, computer science, math, or the natural sciences
2. The social sciences
3. Some other field (e.g., health or business) ? Specify: _______________________
1 [ ] Yes 2 [ ] No
2. The social sciences
1 [ ] Yes 2 [ ] No
3. Some other field (e.g., health or business) ? Specify: _______________________
1 [ ] Yes 2 [ ] No
A28.
During what month and year did you start this job, (that is, your principal job held during the week of April 15, 1997)?
JOB STARTED
Month: |___|___| Year: 19 |___|___|
Month: |___|___| Year: 19 |___|___|
A29.
As of the week of April 15, were you licensed or certified in your occupation? Do NOT include academic degrees (e.g., BA, MA, PhD)
1 [ ] Yes
2 [ ] No
2 [ ] No
A30.
Thinking about the relationship between your work and your education, to what extent was your work on your principal job held during the week of April 15 related to your HIGHEST degree field? Was it...
Mark (X) ONLY one
Mark (X) ONLY one
1 [ ] Closely related (SKIP to A33)
2 [ ] Somewhat related (SKIP to A33)
3 [ ] Not related
2 [ ] Somewhat related (SKIP to A33)
3 [ ] Not related
A31.
(IF NOT RELATED) Did these factors influence your decision to work in an area OUTSIDE OF YOUR HIGHEST DEGREE FIELD?
Mark (X) Yes or No for each
Mark (X) Yes or No for each
1. Pay, promotion opportunities
2. Working conditions (e.g., hours, equipment, working environment)
3. Job location
4. Change in career or professional interests
5. Family-related reasons (e.g., children, spouse's job moved)
6. Job in highest degree field not available
7. Other reason ? Specify: _________________________________________
1 [ ] Yes 2 [ ] No
2. Working conditions (e.g., hours, equipment, working environment)
1 [ ] Yes 2 [ ] No
3. Job location
1 [ ] Yes 2 [ ] No
4. Change in career or professional interests
1 [ ] Yes 2 [ ] No
5. Family-related reasons (e.g., children, spouse's job moved)
1 [ ] Yes 2 [ ] No
6. Job in highest degree field not available
1 [ ] Yes 2 [ ] No
7. Other reason ? Specify: _________________________________________
1 [ ] Yes 2 [ ] No
A32.
Which TWO factors in A31 represent your MOST important reasons for working in an area outside of your HIGHEST degree field? Enter number of appropriate reason from A31 above
1. _________ MOST important reason
2. _________ SECOND MOST important reason (Enter "0" if no second most)
2. _________ SECOND MOST important reason (Enter "0" if no second most)
A33.
The next question is about your work activities on your principal job. Which of the following work activities occupied 10 percent or more of your time during a TYPICAL work week on this job?
Mark (X) Yes or No for each
Mark (X) Yes or No for each
1. Accounting, finance, contracts
2. Applied research - study directed toward gaining scientific knowledge to meet a recognized need
3. Basic research - study directed toward gaining scientific knowledge primarily for its own sake
4. Computer applications, programming, systems development
5. Development - using knowledge gained from research for the production of materials, devices
6. Design of equipment, processes, structures, models
7. Employee relations ? including recruiting, personnel development, training
8. Managing and supervising
9. Production, operations, maintenance (e.g., truck driving, machine tooling, auto/machine repairing)
10. Professional services (e.g., health care, counseling, financial services, legal services)
11. Sales, purchasing, marketing, customer service, public relations
12. Quality or productivity management
13. Teaching
14. Other ? Specify: _________________________________
1 [ ] Yes 2 [ ] No
2. Applied research - study directed toward gaining scientific knowledge to meet a recognized need
1 [ ] Yes 2 [ ] No
3. Basic research - study directed toward gaining scientific knowledge primarily for its own sake
1 [ ] Yes 2 [ ] No
4. Computer applications, programming, systems development
1 [ ] Yes 2 [ ] No
5. Development - using knowledge gained from research for the production of materials, devices
1 [ ] Yes 2 [ ] No
6. Design of equipment, processes, structures, models
1 [ ] Yes 2 [ ] No
7. Employee relations ? including recruiting, personnel development, training
1 [ ] Yes 2 [ ] No
8. Managing and supervising
1 [ ] Yes 2 [ ] No
9. Production, operations, maintenance (e.g., truck driving, machine tooling, auto/machine repairing)
1 [ ] Yes 2 [ ] No
10. Professional services (e.g., health care, counseling, financial services, legal services)
1 [ ] Yes 2 [ ] No
11. Sales, purchasing, marketing, customer service, public relations
1 [ ] Yes 2 [ ] No
12. Quality or productivity management
1 [ ] Yes 2 [ ] No
13. Teaching
1 [ ] Yes 2 [ ] No
14. Other ? Specify: _________________________________
1 [ ] Yes 2 [ ] No
A34.
On which TWO activities in A33 did you work the MOST hours during a typical week on this job? Enter number of appropriate activity from A33 above
1. _________ Activity MOST hours
2. _________ Activity SECOND MOST hours (Enter "0" if no second most)
2. _________ Activity SECOND MOST hours (Enter "0" if no second most)
A35.
Thinking back to when you completed your highest degree, would you say your work during a TYPICAL week on this principal job...
Mark (X) ONLY one
Mark (X) ONLY one
1 [ ] Very similar to what you expected to be doing
2 [ ] Somewhat similar to what you expected to be doing
3 [ ] Not very similar to what you expected to be doing
2 [ ] Somewhat similar to what you expected to be doing
3 [ ] Not very similar to what you expected to be doing
A36.
Did you supervise the work of others as part of your principal job held during the week of April 15?
MARK "YES": If you assigned duties to workers AND recommended or initiated personnel actions such as hiring, firing or promoting
TEACHERS: Do NOT count students
MARK "YES": If you assigned duties to workers AND recommended or initiated personnel actions such as hiring, firing or promoting
TEACHERS: Do NOT count students
1 [ ] Yes
2 [ ] No (SKIP to A38)
2 [ ] No (SKIP to A38)
A37.
(IF YES) How many people did you typically . . .
IF NONE: Enter "0" Number
IF NONE: Enter "0" Number
1. Supervise DIRECTLY? _____ (Number Supervised)
2. Supervise through subordinate supervisors? _____ (Number Supervised)
2. Supervise through subordinate supervisors? _____ (Number Supervised)
A38.
Before deductions, what was your basic ANNUAL salary on this job as of the week of April 15, 1997? (Do NOT include bonuses, overtime, or additional compensation for summertime teaching or research)
IF NOT SALARIED: Please estimate your earned income, excluding business expenses
IF NOT SALARIED: Please estimate your earned income, excluding business expenses
$_________________________.00
Basic Annual Salary/Earned Income
Basic Annual Salary/Earned Income
A39.
During a typical week on this job, how many hours did you usually work?
NUMBER OF HOURS PER WEEK _____
A40.
Including paid vacation and paid sick leave, upon how many weeks per year was your salary based?
NUMBER OF WEEKS PER YEAR _____
A41.
During the week of April 15, 1997, was any of your work on this job supported by CONTRACTS OR GRANTS from the U.S. government?
FEDERAL EMPLOYEES: Please answer "No"
Mark (X) ONLY one
FEDERAL EMPLOYEES: Please answer "No"
Mark (X) ONLY one
1 [ ] Yes
2 [ ] No (SKIP to A43, page 7)
3 [ ] Don't Know (SKIP to A43, page 7)
2 [ ] No (SKIP to A43, page 7)
3 [ ] Don't Know (SKIP to A43, page 7)
A42.
(IF YES) Which Federal agencies or departments were supporting your work?
Mark (X) all that apply
Mark (X) all that apply
1 [ ] Agency for International Development (AID)
2 [ ] Agriculture Department
3 [ ] Commerce Department
4 [ ] Defense Department (DOD)
5 [ ] Department of Education (include NCES, OERI, FIPSE, FIRST)
6 [ ] Energy Department (DOE)
7 [ ] Environmental Protection Agency (EPA)
8 [ ] Health and Human Services Department (EXCLUDING NIH)
9 [ ] Interior Department Administration (NASA)
11 [ ] National Institutes of Health (NIH)
12 [ ] National Science Foundation (NSF)
13 [ ] Transportation Department (DOT)
14 [ ] Other ? Specify: ________________________________
15 [ ] DON'T KNOW SOURCE AGENCY
2 [ ] Agriculture Department
3 [ ] Commerce Department
4 [ ] Defense Department (DOD)
5 [ ] Department of Education (include NCES, OERI, FIPSE, FIRST)
6 [ ] Energy Department (DOE)
7 [ ] Environmental Protection Agency (EPA)
8 [ ] Health and Human Services Department (EXCLUDING NIH)
9 [ ] Interior Department Administration (NASA)
11 [ ] National Institutes of Health (NIH)
12 [ ] National Science Foundation (NSF)
13 [ ] Transportation Department (DOT)
14 [ ] Other ? Specify: ________________________________
15 [ ] DON'T KNOW SOURCE AGENCY
A43.
How would you rate your overall satisfaction with your principal job during the week of April 15th?
Mark (X) ONLY one
Mark (X) ONLY one
1 [ ] Very satisfied
2 [ ] Somewhat satisfied
3 [ ] Somewhat dissatisfied
4 [ ] Very dissatisfied
2 [ ] Somewhat satisfied
3 [ ] Somewhat dissatisfied
4 [ ] Very dissatisfied
A44.
During the week of April 15, 1997, were you working for pay (or profit) at a second job (or business), including part-time, evening, or weekend work?
1 [ ] Yes
2 [ ] No (SKIP to A48)
2 [ ] No (SKIP to A48)
A45.
(IF YES) What kind of work were you doing at your second job during the week of April 15--that is, what was your occupation? Please be as specific as possible, including any area of specialization
IF MORE THAN TWO JOBS THAT WEEK: Answer for the job where you worked the second most hours
IF MORE THAN TWO JOBS THAT WEEK: Answer for the job where you worked the second most hours
__________________________________________________
__________________________________________________
__________________________________________________
A46.
Using the JOB CODES LIST (pages 14-15), choose the code that BEST describes the work you were doing on your second job during the week of April 15.
CODE _____
NOTE ? Job codes range from 010 to 500
NOTE ? Job codes range from 010 to 500
A47.
To what extent was your work on this second job related to your HIGHEST degree field? Was it . . .
Mark (X) ONLY one
Mark (X) ONLY one
1 [ ] Closely related
2 [ ] Somewhat related
3 [ ] Not related
2 [ ] Somewhat related
3 [ ] Not related
The next few questions ask about your work for pay (or profit) in 1996.
A48.
Turning to 1996, including paid vacation and paid sick leave, how many weeks did you work in 1996?
0 [ ] MARK (X) THIS BOX IF NONE AND SKIP TO A51
0 [ ] MARK (X) THIS BOX IF NONE AND SKIP TO A51
NUMBER OF WEEKS WORKED _____
A49.
During the weeks you worked in 1996, how many hours a week did you usually work?
NUMBER OF HOURS WORKED _____
A50.
Counting all jobs held in 1996, what was your TOTAL EARNED income for 1996, BEFORE deductions? Include all wages, salaries, bonuses, overtime, commissions, consulting fees, net income from businesses, summertime teaching or research, postdoctoral appointment, or other work associated with scholarships
TOTAL 1996 EARNED INCOME $ ________________________________.00
0 [ ] MARK (X) THIS BOX IF YOU HAD NO EARNED INCOME IN 1996
0 [ ] MARK (X) THIS BOX IF YOU HAD NO EARNED INCOME IN 1996
A51.
What was your total HOUSEHOLD income before deductions for 1996? In addition to any income listed in A50, please include income from such sources as dividends, interest, social security, pensions, and income earned from your spouse
TOTAL 1996 HOUSEHOLD INCOME $ ______________________.00
0 [ ] MARK (X) THIS BOX IF YOU HAD NO HOUSEHOLD INCOME IN 1996
0 [ ] MARK (X) THIS BOX IF YOU HAD NO HOUSEHOLD INCOME IN 1996
PART B - Past Employment
The next few questions will help us better understand employment changes over time.
B1.
Were you working for pay (or profit) during BOTH of these time periods--the week of April 15, 1995 AND the week of April 15, 1997?
IF YOU WERE A STUDENT: Do NOT count financial aid awards with no work requirement
IF YOU WERE A STUDENT: Do NOT count financial aid awards with no work requirement
1 [ ] Yes
2 [ ] No (SKIP to C1)
2 [ ] No (SKIP to C1)
B2.
(IF YES) During these two time periods?the week of April 15, 1995, and the week of April 15, 1997--were you working for . . .
Mark (X) ONLY one
Mark (X) ONLY one
1 [ ] Same employer AND same job Y SKIP to C1
2 [ ] Same employer BUT different job
3 [ ] Different employer BUT same job
4 [ ] Different employer AND different job
2 [ ] Same employer BUT different job
3 [ ] Different employer BUT same job
4 [ ] Different employer AND different job
B3.
(IF DIFFERENT) Why did you change your employer or your job?
Mark (X) Yes or No for each
Mark (X) Yes or No for each
1. Pay, promotion opportunities
2. Working conditions (e.g., hours, equipment, working environment)
3. Job location
4. Change in career or professional interests
5. Family-related reasons (e.g., children, spouse's job moved)
6. School-related reasons (e.g., returned to school, completed a degree)
7. Laid off or job terminated (includes company closings, mergers, buyouts or grant or contract ended)
8. Retired
9. Other reason ? Specify: _____________________________________
1 [ ] Yes 2 [ ] No
2. Working conditions (e.g., hours, equipment, working environment)
1 [ ] Yes 2 [ ] No
3. Job location
1 [ ] Yes 2 [ ] No
4. Change in career or professional interests
1 [ ] Yes 2 [ ] No
5. Family-related reasons (e.g., children, spouse's job moved)
1 [ ] Yes 2 [ ] No
6. School-related reasons (e.g., returned to school, completed a degree)
1 [ ] Yes 2 [ ] No
7. Laid off or job terminated (includes company closings, mergers, buyouts or grant or contract ended)
1 [ ] Yes 2 [ ] No
8. Retired
1 [ ] Yes 2 [ ] No
9. Other reason ? Specify: _____________________________________
1 [ ] Yes 2 [ ] No
PART C - Other Work and Career Related Experience
C1.
How concerned are you that you might lose your job in the next 12 months?
Mark (X) ONLY one
Mark (X) ONLY one
1 [ ] Very concerned
2 [ ] Somewhat concerned
3 [ ] Not very concerned
2 [ ] Somewhat concerned
3 [ ] Not very concerned
C2.
How concerned are you that someone in your household, other than you, might lose their job in the next 12 months?
0 [ ] MARK (X) THIS BOX IF NO OTHER WORKING ADULT IN HOUSEHOLD AND GO TO C3
Mark (X) ONLY one
0 [ ] MARK (X) THIS BOX IF NO OTHER WORKING ADULT IN HOUSEHOLD AND GO TO C3
Mark (X) ONLY one
1 [ ] Very concerned
2 [ ] Somewhat concerned
3 [ ] Not very concerned
2 [ ] Somewhat concerned
3 [ ] Not very concerned
C3.
Have you ever been offered a buy-out or what is often called ?early retirement?--that is, a cash settlement to induce employees to voluntarily give up a job?
Mark (X) ONLY one
Mark (X) ONLY one
1 [ ] Yes, and accepted the offer
2 [ ] Yes, but did not accept the offer
3 [ ] No
2 [ ] Yes, but did not accept the offer
3 [ ] No
C4.
Since completing your (first) bachelor's degree, have you ever lost or left a job because your employer closed, moved, or underwent restructuring, downsizing or major layoffs?
MARK "Yes": If a partnership or self-employed business closed for economic reasons
MARK "Yes": If a partnership or self-employed business closed for economic reasons
1 [ ] Yes
2 [ ] No (SKIP to C9)
2 [ ] No (SKIP to C9)
C5.
(IF LOST OR LEFT JOB) For which of the following reasons did you lose or leave that job (or jobs)?
Mark (X) Yes or No for each
Mark (X) Yes or No for each
1. Your self-operated business ended
2. Your company or the facility or agency where you worked closed down
3. Your company or the facility or agency where you worked moved to another location
4. The work or services of your company or the facility or agency where you worked was reorganized or restructured
5. Your company or the facility or agency where you worked was taken over by another organization
6. Your company or the facility or agency where you worked had insufficient business, revenue or work
7. Some other reason ? Specify: ________________________________
1 [ ] Yes 2 [ ] No
2. Your company or the facility or agency where you worked closed down
1 [ ] Yes 2 [ ] No
3. Your company or the facility or agency where you worked moved to another location
1 [ ] Yes 2 [ ] No
4. The work or services of your company or the facility or agency where you worked was reorganized or restructured
1 [ ] Yes 2 [ ] No
5. Your company or the facility or agency where you worked was taken over by another organization
1 [ ] Yes 2 [ ] No
6. Your company or the facility or agency where you worked had insufficient business, revenue or work
1 [ ] Yes 2 [ ] No
7. Some other reason ? Specify: ________________________________
1 [ ] Yes 2 [ ] No
C6.
In what year did you lose or leave that job?if more than one, please answer for the most recent occurrence.
Year: 19 |___|___|
C7.
From the time you actively began your search, about how many months did it take to find a new job (answer for most recent occurrence)?
0 [ ] MARK (X) THIS BOX IF YOU HAVE NOT FOUND ANOTHER JOB AND SKIP TO C9
NUMBER OF MONTHS _____ (Enter "0" if less than one month)
NUMBER OF MONTHS _____ (Enter "0" if less than one month)
C8.
Compared to the job you had, did your new job offer you significantly more, about the same, or significantly less in terms of:
a. Salary
b. Level of responsibility
c. Utilizing your knowledge or skills
1 [ ] Significantly More 2 [ ] About the Same 3 [ ] Significantly Less
b. Level of responsibility
1 [ ] Significantly More 2 [ ] About the Same 3 [ ] Significantly Less
c. Utilizing your knowledge or skills
1 [ ] Significantly More 2 [ ] About the Same 3 [ ] Significantly Less
C9.
If you had the chance to do it over again, knowing what you do now, how likely is it that you would choose the same field of study for your highest degree?
1 [ ] Very likely
2 [ ] Somewhat likely
3 [ ] Not at all likely
2 [ ] Somewhat likely
3 [ ] Not at all likely
C10.
During the past year, did you attend any professional society or association meetings or professional conferences? Include regional, national, or international meetings
1 [ ] Yes
2 [ ] No
2 [ ] No
C11.
To how many national or international professional societies or associations do you currently belong?
Number _____ OR 0 [ ] NONE
C12.
During the past year, did you attend any WORK-RELATED workshops, seminars, or other work-related training activities? Do NOT include college courses - these will be discussed in PART D, page 11
Do NOT include professional meetings unless you attended a special training session conducted at the meeting/conference
Do NOT include professional meetings unless you attended a special training session conducted at the meeting/conference
1 [ ] Yes
2 [ ] No (SKIP to D1, page 11)
2 [ ] No (SKIP to D1, page 11)
C13.
(IF YES) During the past year, in which of the following areas did you attend work-related workshops, seminars, or other work-related training activities? In those areas marked "yes," please answer the follow-up questions.
Types of Work-Related Training:
For Any Training Marked "Yes": Answer A-
For Any Training Marked "Yes": Answer A-
1. Management or supervisor training 1 [ ] Yes 2 [ ] No
2. Training in your occupational field
3. General professional training (e.g., public speaking, business writing)
4. Other work ? related training ? Specify ____________________________
a. Record Total Number of Days in Training _____
b. Did you pay for any of this training yourself? 1 [ ] Yes 2 [ ] No
c. Number of Training Days You Paid For _____
b. Did you pay for any of this training yourself? 1 [ ] Yes 2 [ ] No
c. Number of Training Days You Paid For _____
2. Training in your occupational field
a. Record Total Number of Days in Training _____
b. Did you pay for any of this training yourself? 1 [ ] Yes 2 [ ] No
c. Number of Training Days You Paid For _____
b. Did you pay for any of this training yourself? 1 [ ] Yes 2 [ ] No
c. Number of Training Days You Paid For _____
3. General professional training (e.g., public speaking, business writing)
a. Record Total Number of Days in Training _____
b. Did you pay for any of this training yourself? 1 [ ] Yes 2 [ ] No
c. Number of Training Days You Paid For _____
b. Did you pay for any of this training yourself? 1 [ ] Yes 2 [ ] No
c. Number of Training Days You Paid For _____
4. Other work ? related training ? Specify ____________________________
a. Record Total Number of Days in Training _____
b. Did you pay for any of this training yourself? 1 [ ] Yes 2 [ ] No
c. Number of Training Days You Paid For _____
b. Did you pay for any of this training yourself? 1 [ ] Yes 2 [ ] No
c. Number of Training Days You Paid For _____
C14.
For which of the following reasons did you attend training activities during the past year?
Mark (X) Yes or No for each
Mark (X) Yes or No for each
1. To facilitate a change in your occupational field
2. To gain FURTHER skills or knowledge in your occupational field
3. For licensure/certification
4. To increase opportunities for promotion/advancement/higher salary
5. To learn skills or knowledge needed for a recently acquired position
6. Required or expected by employer
7. Other ? Specify: ______________________________
1 [ ] Yes 2 [ ] No
2. To gain FURTHER skills or knowledge in your occupational field
1 [ ] Yes 2 [ ] No
3. For licensure/certification
1 [ ] Yes 2 [ ] No
4. To increase opportunities for promotion/advancement/higher salary
1 [ ] Yes 2 [ ] No
5. To learn skills or knowledge needed for a recently acquired position
1 [ ] Yes 2 [ ] No
6. Required or expected by employer
1 [ ] Yes 2 [ ] No
7. Other ? Specify: ______________________________
1 [ ] Yes 2 [ ] No
C15.
What was your most important reason for attending training activities?
Enter number of appropriate reason from C14 above
Enter number of appropriate reason from C14 above
MOST IMPORTANT REASON FROM C14 _____
PART D - Background Information
D1.
Between April 1995 and April 1997, did you take any college or university courses or enroll in a college or university for other reasons, such as completing a Master's or PhD?
1 [ ] Yes
2 [ ] No (SKIP to D11, page 12)
2 [ ] No (SKIP to D11, page 12)
D2.
(IF YES) In which college or university department were you primarily taking classes or doing research, etc. (e.g., English, chemistry)?
DEPARTMENT _____________________________
D3.
During that time, toward what degree or certificate, if any, were you (or are you) working?
0 [ ] MARK (X) THIS BOX IF NO SPECIFIC DEGREE OR CERTIFICATE AND SKIP TO D7
IF MORE THAN ONE APPLIES: Mark the highest level
Mark (X) ONLY one
0 [ ] MARK (X) THIS BOX IF NO SPECIFIC DEGREE OR CERTIFICATE AND SKIP TO D7
IF MORE THAN ONE APPLIES: Mark the highest level
Mark (X) ONLY one
1 [ ] Bachelor's degree
2 [ ] Post baccalaureate certificate
3 [ ] Master's degree (including MBA)
4 [ ] Post master's certificate
5 [ ] Doctorate (e.g., Ph.D., D.S.C, D.Sc., Ed.D.)
6 [ ] Other professional degree (e.g., JD, LLB, ThD, MD, DDS) ? Specify: ________________
7 [ ] Other ? Specify: _________________________________
2 [ ] Post baccalaureate certificate
3 [ ] Master's degree (including MBA)
4 [ ] Post master's certificate
5 [ ] Doctorate (e.g., Ph.D., D.S.C, D.Sc., Ed.D.)
6 [ ] Other professional degree (e.g., JD, LLB, ThD, MD, DDS) ? Specify: ________________
7 [ ] Other ? Specify: _________________________________
D4.
Between April 1995 and April 1997, did you complete a degree or certificate?
1 [ ] Yes
2 [ ] No (SKIP to D7)
2 [ ] No (SKIP to D7)
D4a.
(IF YES) What degree or certificate did you receive? Enter number of appropriate TYPE OF DEGREE/CERTIFICATE received from D3 above
TYPE OF DEGREE/CERTIFICATE FROM D3 _____________
D5.
In what month and year was this degree or certificate awarded?
IF YOU COMPLETED MORE THAN ONE: Enter the date for the highest degree or certificate awarded
IF YOU COMPLETED MORE THAN ONE: Enter the date for the highest degree or certificate awarded
Month: |___|___| Year: 19 |___|___|
D6.
From which academic institution did you receive this degree or certificate?
School name: ______________________________
City/Town: ________________________________
State/Foreign country: _______________________
City/Town: ________________________________
State/Foreign country: _______________________
D7.
What was your primary field of study during that time?
PRIMARY FIELD OF STUDY
______________________________________________
____________________________________________________
______________________________________________
____________________________________________________
D8.
Using the EDUCATION CODES (pages 16-17), choose the code that BEST describes the field of study for this degree or certificate.
CODE _____
NOTE ? Education codes range from 601 to 995
NOTE ? Education codes range from 601 to 995
D9.
For which of the following reasons were you taking classes or enrolled between April 1995 and April 1997?
Mark (X) Yes or No for each
Mark (X) Yes or No for each
1. To gain further education before beginning a career
2. To prepare for graduate school
3. To change your academic or occupational field
4. To gain FURTHER skills or knowledge in your academic or occupational field
5. For licensure/certification
6. To increase opportunities for promotion, advancement, or higher salary
7. Required or expected by employer
8. For leisure/personal interest
9. Other ? Specify: ____________________________
1 [ ] Yes 2 [ ] No
2. To prepare for graduate school
1 [ ] Yes 2 [ ] No
3. To change your academic or occupational field
1 [ ] Yes 2 [ ] No
4. To gain FURTHER skills or knowledge in your academic or occupational field
1 [ ] Yes 2 [ ] No
5. For licensure/certification
1 [ ] Yes 2 [ ] No
6. To increase opportunities for promotion, advancement, or higher salary
1 [ ] Yes 2 [ ] No
7. Required or expected by employer
1 [ ] Yes 2 [ ] No
8. For leisure/personal interest
1 [ ] Yes 2 [ ] No
9. Other ? Specify: ____________________________
1 [ ] Yes 2 [ ] No
D10.
Were ANY of your school-related costs for taking college or university courses during this time paid for by an employer?
1 [ ] Yes
2 [ ] No
2 [ ] No
D11.
As of the week of April 15 were you . . .
Mark (X) ONLY one
Mark (X) ONLY one
1 [ ] Married
2 [ ] Widowed (SKIP to D14)
3 [ ] Separated (SKIP to D14)
4 [ ] Divorced (SKIP to D14)
5 [ ] Never Married (SKIP to D14)
2 [ ] Widowed (SKIP to D14)
3 [ ] Separated (SKIP to D14)
4 [ ] Divorced (SKIP to D14)
5 [ ] Never Married (SKIP to D14)
D12.
(IF MARRIED) During the week of April 15, was your spouse working for pay (or profit) at a full-time or part-time job?
1 [ ] Yes, full-time
2 [ ] Yes, part-time
3 [ ] No (SKIP to D14)
2 [ ] Yes, part-time
3 [ ] No (SKIP to D14)
D13.
(IF YES) Did your spouse's duties on this job require the technical expertise of a bachelor's degree or higher in . . .
Mark (X) Yes or No for each
Mark (X) Yes or No for each
1. Engineering, computer science, math or the natural sciences
2. The social sciences
3. Some other field (e.g., health or business) ? Specify: _____________________
1 [ ] Yes 2 [ ] No
2. The social sciences
1 [ ] Yes 2 [ ] No
3. Some other field (e.g., health or business) ? Specify: _____________________
1 [ ] Yes 2 [ ] No
D14.
During the week of April 15, did you have any children living with you as part of your family?
Only count children who lived with you at least 50 percent of the time
Only count children who lived with you at least 50 percent of the time
1 [ ] Yes (GO to D15)
2 [ ] No (SKIP to D16)
2 [ ] No (SKIP to D16)
D15.
(IF YES) How many of these children living with you as part of your family were...
IF NO CHILDREN IN A CATEGORY: Enter "0"
IF NO CHILDREN IN A CATEGORY: Enter "0"
_____ 1. Under age 2
_____ 2. Aged 2-5
_____ 3. Aged 6-11
_____ 4. Aged 12-17
_____ 5. Aged 18 or older
_____ 2. Aged 2-5
_____ 3. Aged 6-11
_____ 4. Aged 12-17
_____ 5. Aged 18 or older
D16.
During the week of April 15, 1997, were you living in the United States or one of its territories, or were you living in another country?
1 [ ] United States or one of its territories
2 [ ] Another country
2 [ ] Another country
D17.
As of the week of April 15, 1997 were you a . . .
Mark (X) ONLY one
Mark (X) ONLY one
U.S. Citizen
1 [ ] Native Born (SKIP to D19)
2 [ ] Naturalized (SKIP to D19)
Non-U.S. Citizen
3 [ ] With a Permanent U.S. Resident Visa
4 [ ] With a Temporary U.S. Resident Visa
5 [ ] Living outside the United States
1 [ ] Native Born (SKIP to D19)
2 [ ] Naturalized (SKIP to D19)
Non-U.S. Citizen
3 [ ] With a Permanent U.S. Resident Visa
4 [ ] With a Temporary U.S. Resident Visa
5 [ ] Living outside the United States
D18.
(IF NON-U.S. CITIZEN) Of which country are you a citizen?
COUNTRY ______________________________________
D19.
What is your birthdate?
Month: |___|___| Day: |___|___| Year: 19 |___|___|
The next question is designed to help us better understand the career paths of individuals with different physical abilities.
D20.
What is the USUAL degree of difficulty you have with . . .
1. SEEING words or letters in ordinary newsprint (with glasses/contact lenses if you usually wear them)
2. HEARING what is normally said in conversation with another person (with hearing aid, if you usually wear one)
3. WALKING without human or mechanical assistance or using stairs
4. LIFTING or carrying something as heavy as 10 pounds, such as a bag of groceries
1 [ ] None 2 [ ] Slight 3 [ ] Moderate 4 [ ] Severe 5 [ ] Unable to Do
2. HEARING what is normally said in conversation with another person (with hearing aid, if you usually wear one)
1 [ ] None 2 [ ] Slight 3 [ ] Moderate 4 [ ] Severe 5 [ ] Unable to Do
3. WALKING without human or mechanical assistance or using stairs
1 [ ] None 2 [ ] Slight 3 [ ] Moderate 4 [ ] Severe 5 [ ] Unable to Do
4. LIFTING or carrying something as heavy as 10 pounds, such as a bag of groceries
1 [ ] None 2 [ ] Slight 3 [ ] Moderate 4 [ ] Severe 5 [ ] Unable to Do
D21.
0 [ ] MARK (X) THIS BOX IF YOU ANSWERED "NONE" TO ALL ACTIVITIES IN D20 AND SKIP TO D23
D22.
What is the earliest age at which you FIRST began experiencing ANY difficulties in ANY of these areas?
AGE _____ OR 0 [ ] SINCE BIRTH
D23.
In case we need to clarify some of the information you have provided, please list a phone number (and an e-mail address if applicable) where you can be reached.
Daytime |___|___|___|-|___|___|___|-|___|___|___|___|
Area Code Number
Evening |___|___|___|-|___|___|___|-|___|___|___|___|
Area Code Number
E-mail Address __________________________________________
Area Code Number
Evening |___|___|___|-|___|___|___|-|___|___|___|___|
Area Code Number
E-mail Address __________________________________________
D24.
Since we are interested in how education and employment change over time, we may be recontacting you in 1999. To help us find you, please provide the name, address, and telephone number of two people who are likely to know where you can be reached. DO NOT INCLUDE SOMEONE WHO LIVES IN YOUR HOUSEHOLD
As with all the information provided in this questionnaire, complete confidentiality will be provided. These people will only be contacted if we cannot find you in 1999
____________________________________________
Name
____________________________________________
Number and Street
_________________________|_______|___________
City/Town State Zip Code
____________________________________________
Country (If outside U.S.)
|___|___|___|-|___|___|___|-|___|___|___|___|
Area Code Number
Name
____________________________________________
Number and Street
_________________________|_______|___________
City/Town State Zip Code
____________________________________________
Country (If outside U.S.)
|___|___|___|-|___|___|___|-|___|___|___|___|
Area Code Number
____________________________________________
Name
____________________________________________
Number and Street
_________________________|_______|___________
City/Town State Zip Code
____________________________________________
Country (If outside U.S.)
|___|___|___|-|___|___|___|-|___|___|___|___|
Area Code Number
Name
____________________________________________
Number and Street
_________________________|_______|___________
City/Town State Zip Code
____________________________________________
Country (If outside U.S.)
|___|___|___|-|___|___|___|-|___|___|___|___|
Area Code Number
D25.
PLEASE TURN TO THE BACK COVER FOR THE LAST QUESTION (D26).
D26.
Is the name and address information on the label the best one for us to use for any future mailings?
1 [ ] Yes
2 [ ] No - Please make name and address changes as needed below. Please print clearly.
2 [ ] No - Please make name and address changes as needed below. Please print clearly.
Title: ____________ First name: ____________ Middle initial ____ Last name: _______________
Number and street: _________________ Apartment number: ____ City and town: _________ State: ___ ZIP Code: ____
THANK YOU FOR COMPLETING THE QUESTIONNAIRE
Please return the completed form in the envelope provided. If you lose the envelope and want another, call 1-800-523-3205. Our address is:
DIRECTOR
BUREAU OF THE CENSUS
1201 E 10TH ST
JEFFERSONVILLE IN 47132-0001
BUREAU OF THE CENSUS
1201 E 10TH ST
JEFFERSONVILLE IN 47132-0001