Section One: Facts About You like to ask some basic questions about you. Your answers will not be used to identify you in any way. First, we’d Instead, your answers will help us understand how different groups (like men or women, or people of similar ages) feel about substance abuse and HIV prevention. How would you describe yourself? (Gender) How would you describe yourself? (Sexual orientation) Male  Female Straight or heterosexual   Transgender Bisexual   Male to female Gay or lesbian   Female to male Unsure   In what year were you born? (Enter all four digits How well do you speak English? of the year in the boxes below, and fill in corresponding circles) Very well  Well  Not well  Not at all  1 0 0 0 What is your primary spoken language? 1 1 1 2 2 2 English 3 3 3  Spanish 4 4 4  Asian (Chinese, Japanese, or other) 5 5 5  American Indian (Apache, Blackfoot, Navajo, 6 6 6  7 7 7 or other) 8 8 8 Other  9 9 9 What is the highest level of education you have Are you of Hispanic, Latino/a, or Spanish finished, whether or not you received a degree? origin? (If yes, you may select one or more (Mark the highest grade you have completed.) categories) Elementary school  No, not of Hispanic, Latino/a, or Spanish origin Middle school  Yes, Mexican, Mexican American, Chicano/a High school  Yes, Puerto Rican Community college or technical or trade school  Yes, Cuban Four-year college  Yes, another Hispanic, Latino/a, or Spanish Beyond four-year college  origin Are you currently attending college? What is your race? (Select one or more) No  White Yes, I live on campus   Black or African American Yes, I live off campus   American Indian or Alaska Native  Asian Indian Which of the following best describes you? (Mark  Chinese the one that fits best)  Filipino  Japanese Employed full-time (35+ hours per week)   Korean Employed part-time   Vietnamese Unemployed (full-time student)   Other Asian Unemployed (other reason)   Native Hawaiian  Guamanian or Chamorro  Samoan  Other Pacific Islander 
Section One: Facts About You First, we’d like to ask some basic questions about you. Your answers will not be used to identify you in any way. Instead, your answers will help us understand how different groups (like men or women, or people of similar ages) feel about substance abuse and HIV prevention. How would you describe yourself? (Gender)  Male  Female  Transgender  Male to female  Female to male In what year were you born? (Enter all four digits of the year in the boxes below, and fill in corresponding circles) Are you of Hispanic, Latino/a, or Spanish origin? (If yes, you may select one or more categories) No, not of Hispanic, Latino/a, or Spanish origin Yes, Mexican, Mexican American, Chicano/a Yes, Puerto Rican Yes, Cuban Yes, another Hispanic, Latino/a, or Spanish origin What is your race? (Select one or more)  White  Black or African American  American Indian or Alaska Native  Asian Indian  Chinese  Filipino  Japanese  Korean  Vietnamese  Other Asian  Native Hawaiian  Guamanian or Chamorro  Samoan  Other Pacific Islander How would you describe yourself? (Sexual orientation)  Straight or heterosexual  Bisexual  Gay or lesbian  Unsure How well do you speak English?  Very well  Well  Not well  Not at all What is your primary spoken language?  English  Spanish  Asian (Chinese, Japanese, or other)  American Indian (Apache, Blackfoot, Navajo, or other)  Other What is the highest level of education you have finished, whether or not you received a degree? (Mark the highest grade you have completed.)  Elementary school  Middle school  High school  Community college or technical or trade school  Four-year college  Beyond four-year college Are you currently attending college?  No  Yes, I live on campus  Yes, I live off campus Which of the following best describes you? (Mark the one that fits best)  Employed full-time (35+ hours per week)  Employed part-time  Unemployed (full-time student)  Unemployed (other reason) 3 3 1 2 3 4 5 6 5 5 0 1 2 4 6 7 8 9 0 1 2 4 6 7 8 9 0 1 7 8 9