Circle the appropriate
answers or fill in the blank.
1. Are you male or female?SEX
Male1 Female2
2. What racial or ethnic group do you primarily identify yourself as?RACE
White1 Hispanic2
African American3 Asian American4 Native
American5 Other6
3. What is your sexual orientation?SO
Heterosexual1
Gay2 Lesbian2 Bisexual3 Other4
________________
4. What is your marital status?MARITAL
Single1
Married2 Divorced3 Widowed4
5. On average, how many hours
a week do you spend doing household chores?HOUSE________??
6. Are you currently employed outside of the home?EMPLOY No1 Yes2
if yes,
on average how many hours a week do you work outside of the home?HOURS__________??
7. If you answered yes
to question 6, what is your average. hourly
wage?WAGE ________????
8. On average, how many hours
a week do you spend studying?STUDY_______??
9. How many credit hours
are you currently enrolled in?ENROLL_____??
10. How many people have
you been sexually active with in the past year?ACTIVE_____??
Always1
Almost always2 Sometimes3 Rarely4
Never5
12. How old are you (age
at your last birthday)?AGE_____??
13. What is your current
GPA?GPA___.___??
1A. I would interrupt my career for 4 or more years to provide childcare for our children.
2B. I would work part-time and hire childcare part-time
3C. I would continue to work and hire childcare 40+ hours a week
4D. I would ask my partner to work part-time and hire part-time childcare.
16. Do you have a friend or family member who you know is NOT heterosexual?HETERO No1 Yes2
17. How do you feel about abortion?ABORT
2B. Abortion is wrong except in cases when the mother's life is at risk.
3C. Abortion is wrong except in cases when the mother's life is at risk, rape and incest.
4D. Abortion is a personal choice made by both parents with the assistance of their physician.
5E.
Abortion is a personal choice made by the women with the assistance
of her physician.
19. Do you personally know
someone who has contracted the HIV virus?HIV No1
Yes2
20. Have you experienced
racial discrimination during the last year?RD No1
Yes2
21. Have you experienced
sexual discrimination during the last year?SD No1
Yes2
22. When is sexual intercourse acceptable between two adults?SI
1A. Sexual intercourse is acceptable after marriage when trying to procreate.
2B. Sexual intercourse is acceptable after marriage.
3C. Sexual intercourse is acceptable when the adult couple is in love.
4D.
Sexual intercourse is acceptable between two consenting adults.
V24. How do you feel about gay relationships?
1A. Very Comfortable 4D. Somewhat Uncomfortable
2B. Comfortable 5E. Uncomfortable
3C.
Somewhat Comfortable 6F. Offended
V25. How do you feel about lesbian relationships?
1A. Very Comfortable 4D. Somewhat Uncomfortable
2B. Comfortable 5E. Uncomfortable
3C.
Somewhat Comfortable 6F. Offended
Use this range to respond to the following opinion statements (#26-40).
V27. Marijuana should be legalized in the United States? _____
V28. Women should be allowed to fight in combat situations. ______
V29. Interracial dating relationships are wrong. _____
V30. Sexual violence is common in the U.S._____
V31. Racism currently does NOT detrimentally affect job opportunities for minority groups. _____
V35. Racism negatively affects housing opportunities for minorities._____
V37. Federal assistance for unmarried women with children should be reduced._____
V38. Affirmative action is a fair means of integrating a segregated workforce._____
V39. Gay men and lesbians should NOT be able to teach young children._____
V40.
Sexual harassment is a common problem in the workplace._____
V41. What U.S. political party do you feel most represents your positions on current issues?
1A. Democratic party 3C. Republican party
2B.
Independent party 4D. Other_______________________
V 42. How would you describe yourself on social issues?
1A. Very Conservative 4D. Slightly Liberal
3C.
Slightly Conservative 6F.
Very Liberal
V 43. How would you describe yourself on economic issues?
1A. Very Conservative 4D. Slightly Liberal
3C. Slightly Conservative 6F. Very Liberal
44. Who would you like to see win the 1996 presidential election?________