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21
<br /> . Print name of Pe 7. What is this person's race?
<br /> First Name MI Mark❑X one or more boxes AND print origins.
<br /> ❑ F-1 White-Print,for example,German,Irish,English,Italian,
<br /> Lebanese,Egyptian,etc.
<br /> Last Name(s)
<br /> ❑ Black or African Am.-Print,for example,African American,
<br /> 2. Does this person usually live or stay somewhere else? Jamaican,Haitian,Nigerian,Ethiopian,Somali,etc.
<br /> Mark❑X all that apply.
<br /> ❑ No
<br /> American Indian or Alaska Native-Print name of enrolled or
<br /> ❑ Yes,with a parent or principal tribe(s),for example,Navajo Nation,Blackfeet Tribe,
<br /> El Yes,for college
<br /> other relative Mayan,Aztec,Native Village of Barrow Inupiat Traditional
<br /> ❑ Yes,for a military assignment ❑ Yes,at a seasonal or Government,Nome Eskimo Community,etc,
<br /> second residence
<br /> ❑ Yes,for a job or business ❑ Yes, in a jail or prison
<br /> ❑ Yes, in a nursing home ❑ Yes,for another reason
<br /> ❑ Chinese ❑ Vi eO Native Hawaiian
<br /> 3. How is this person related to Person 1?Mark❑X ONE box. El Filipino o an ❑ Samoan
<br /> !._� Opposite-sex husband/wife/spouse LJ Father or mother
<br /> El Asian Indian se ElChamorro
<br /> ❑ Opposite-sex unmarried partner ❑ Grandchild
<br /> Oth sian- ❑ Other Pacific Islander-
<br /> ❑ Same-sex husband/wife/spouse Prin,f example, Print,for example,
<br /> ❑ Parent-in-law is n, a,bodian, Tongan, Fijian,
<br /> W(n .AW Marshallese,etc.
<br /> ❑ Same-sex unmarried partner ❑ Son-in-law or daughter-in-law
<br /> ❑ Biological son or daughter ❑ Other relative
<br /> ❑ Adopted son or daughter ❑ Roommate or hous m t�
<br /> ❑ Some other race-Print race or origin. 7
<br /> ❑ Stepson or stepdaughter ❑ Foster chil
<br /> ❑ Brother or sister ❑ Oth nrelat e
<br /> D
<br /> 4. What is this person's sex?Mark o .
<br /> Male Female
<br /> Q
<br /> 5. What is this perso is this person's date of
<br /> birth?For babie �th r old, do not write the age in
<br /> months. Write e
<br /> Print numbers in boxes.
<br /> Age o 0 Month Day Year of birth
<br /> i
<br /> years i 1
<br /> 4 NOTE:Please answer BOTH Question 6 about Hispanic
<br /> origin and Question 7 about race.For this census,Hispanic
<br /> origins are not races.
<br /> 6. Is this person of Hispanic,Latino,or Spanish origin?
<br /> No,not of Hispanic,Latino,or Spanish origin
<br /> LJ Yes,Mexican,Mexican Am.,Chicano
<br /> ❑ Yes,Puerto Rican
<br /> ❑ Yes,Cuban
<br /> ❑ Yes,another Hispanic,Latino,or Spanish origin-Print,for
<br /> example,Salvadoran,Dominican, Colombian, Guatemalan,
<br /> Spaniard,Ecuadorian,etc.7 If more people were counted in Question 1 on
<br /> the front page, continue with Person 3 on the
<br /> L ------ next page.
<br /> 3
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