Possible Futures Survey- Form B: Required Information ( © H. Lips, 2000)     
.. b 

Please give us some information about yourself.
Your sex (circle one): female(1)          male(2)
             
Your ethnic origin (circle one): African American(1)   Asian American(2)
European American(3)   Hispanic American(4)
Native American(5)   Other(7)____________
Your age (in years):__________
     
Your year in college (circle one:) Freshman(3)   Sophomore(4)
Junior(5)   Senior(6)
Other(7)_____________
Your major:_________________________________________
Please turn the page and continue with the survey               click here for Form Page 1b
        

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Web Page Created by:  W. Andrew   &   H. Lips
Last Updated: May 17th , 2001