Questionnaire Text

Questionnaire form view entire document:  text  image

7. Is this person of Spanish/Hispanic origin or descent?
Fill one circle.

[] No (not Spanish/Hispanic)
[] Yes, Mexican, Mexican-Amer., Chicano
[] Yes, Puerto Rican
[] Yes, Cuban
[] Yes, other Spanish/Hispanic


[A person is of Spanish/Hispanic origin or descent if the person identifies his or her ancestry with one of the listed groups, that is, Mexican, Puerto Rican, etc. Origin or descent (ancestry) may be viewed as the nationality group, the lineage, or country in which the person or the person's parents or ancestors were born.]