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Safe-Sex Knowledge, Sexual Behavior, and Drug Use A thesis

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Appendix A: Survey Instrument<br />

1. What is your gender?<br />

Male___ Female___ Transgender___ Other___<br />

If “Other,” please<br />

explain:_______________________________________<br />

2. Do you identify as:<br />

Gay___ Bisexual___ Straight___ Other___(what?_________) Not<br />

Sure___<br />

3. Do you consider yourself either Hispanic <strong>and</strong>/or Latino?<br />

Yes___ No___ Don’t Know___ Not Sure___<br />

4. What is your race? (check all that apply)<br />

Black or African American ___<br />

Asian<br />

___<br />

Hawaiian or Pacific Isl<strong>and</strong>er ___<br />

Alaska Native<br />

___<br />

White<br />

___<br />

American Indian<br />

___<br />

Don’t Know<br />

___<br />

5. As of this week, are you working…<br />

Full-time___ Part-time___ Not working now___ On Disability___<br />

Retired___<br />

6. Are you currently a student? Yes___ No___<br />

If Yes, where: High School___ College___ Other<br />

(where?_______________)<br />

7. What is the highest level of education you have completed?<br />

Highest grade completed____<br />

High school diploma or GED____<br />

Some college classes taken, but no degree yet____<br />

Associate’s degree (AA, etc.) ____<br />

Bachelors’s degree (BA, BA, etc.) ____<br />

Advanced degree (MA, MS, MD, MBA, JD, EdD, PhD, etc.) ____<br />

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