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Ethnicity/Race Questionnaire
Please complete the survey questions.
*
1: Name (last name, first name):
2: School:
Collins Elementary
Collins Middle
Glennville Elementary
Glennville Middle
Reidsville Elementary
Reidsville Middle
Tattnall Co. High School
Central Office
Other
( Up to 9 choices are allowed )
*
3: Are you Hispanic/Latino?
No, not Hispanic/Latino
Yes, Hispanic/Latino (A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.)
*
4: What is your race? (Choose one or more)
American Indian or Alaska Native
Asian (Origins in original peoples of Far East, SE Asia, or Indian subcontinent)
Black or African American (Origins in any of the black racial groups of Africa)
Native Hawaiian or Other Pacific Islander (origins in original peoples of Hawaii, Guam, Samoa, other Pacific Islands)
White ( Origins in original peoples of Europe, Middle East, or North Africa)
( Up to 5 choices are allowed )
Survey By: LH 6/10/2009
Created on 6/11/2009 3:18:33 PM - Last updated on9/21/2009 9:37:13 AM
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