Questionnaire Text

Questionnaire form view entire document:  text  image

2. Relationship to Person 1
[] Husband or wife or Person 1
[] Common-law partner of Person 1
[] Son or daughter of Person 1
[] Father or mother of Person 1
[] Brother or sister of Person 1
[] Son-in-law or daughter-in-law of Person 1
[] Father-in-law or mother-in-law of Person 1
[] Brother-in-law or sister-in-law of Person 1
[] Grandchild of Person 1
[] Nephew or niece of Person 1
[] Other relative of Person 1 (Print below) ____
[] Lodger
[] Lodger's husband or wife
[] Lodger's son or daughter
[] Room-mate
[] Employee
[] Other non-relative (Print below) ____

For each person in this household, mark "X" one box only to describe his or her relationship to Person 1. If you mark the box "Other relative" or "Other non-relative", print in the relationship to Person 1. Some examples of the "Other" relationships are:
Grandmother
Uncle
Room-mate's daughter
Employee's husband

For further examples and special cases, see guidelines.


3. Date of birth

If exact date is not known, enter best estimate.
Day _ _
Month _ _
Year _ _ _ _