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23
<br /> 1. Print name of 7. What is this person's race?
<br /> First Name MI Mark VX one or more boxes AND print origins.
<br /> n 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 IXJ all that apply.
<br /> i_ No
<br /> American Indian or Alaska Native—Print name of enrolled or
<br /> ❑ Yes,for college ❑ Yes,with a parent or principal tribe(s),for example,Navajo Nation,Blackfeet Tribe,
<br /> other relative Mayan,Aztec,Native Village of Barrow Inupiat Traditional
<br /> ❑ Yes, at a seasonal or Government,Nome Eskimo Community,etc.
<br /> Yes,for a military assignment ❑
<br /> second residence (
<br /> El ❑Yes,for a job or business ` I
<br /> Yes, in a jail or prison
<br /> Yes, in a nursing home ❑ Yes,for another reason
<br /> ❑ Chinese ❑ Vieth so Native Hawaiian
<br /> 3. How is this person related to Person 1?Mark❑X ONEbox. El Filipino ran 1 Samoan
<br /> Opposite-sex husband/wife/spouse Li Father or mother v
<br /> ❑ Asian Indian e ❑ Chamorro
<br /> LJ Opposite-sex unmarried partner ❑ Grandchild
<br /> ❑ Othe ian— ❑ Other Pacific Islander—
<br /> ❑ Same-sex husband/wife/spouse Print, xam le, Print,for example,
<br /> ❑ Parent-in-law 'st i, odian, Tongan, Fijian,
<br /> to t Marshallese,etc.7
<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 house e
<br /> Some other race—Print race or origin.�
<br /> ❑ Stepson or stepdaughter ❑ Foster child
<br /> ❑ Brother or sister ❑ Othe relati
<br /> 4. What is this person's sex?Mark X D
<br /> Male Female
<br /> Q
<br /> 5. What is this person' a is this person's date of
<br /> birth?For babies s ha 1 old,do not write the age in
<br /> months. Write
<br /> Print numbers in boxes.
<br /> Age on ri �Month � Day � Year of birth
<br /> ears I I
<br /> 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 /> f.J No,not of Hispanic,Latino,or Spanish origin
<br /> ❑ 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.W 4 If more people were counted in Question 1 on
<br /> -- ]——I —I ] the front page, continue with Person 5 on the
<br /> next page.
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