09-21-99 Regular Meeting of La Porte Complete Count Committee

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~~•t~ ~x~ t~J What is this person's name? Print the name of Person 1 from page 2. last Name First Name MI What is this person's race? Mark Q one or more races to indicate what this person considers himself/herself to be. O White O Black, African Am., or Negro O American Indian or Alaska Native -Print name of enrolled or principal tribe. ~ ^ Asian Indian O Native Hawaiian O Chinese ~ ~ O Guamanian or ^ Filipino ~~ Chamorro ^ Japanese ~;~;;~ _ ~" O Samoan "~ O Korean~~ "~.:~ ~~> O Other Pacific O vetn~rres? 1-` Islander - ^ OtF~e A=ian - Print race. ~ Print race. 7 ~l What is this person's telephone number? We may ~ ti contact this person if we don't understand an answer. . Area Code + Number ,~ '~ • ~~ ~ ~` ~ ~ O Some other race -Print race. ~ What is this person's sex? Mark ©ONE box. .~ ~~;~~`~-~., ^ Male _ ~~• `~ . ~ OFemale `~• f;;~> ~ ~ What is this person's age and what isthi5 person's date of birth? Age on April 1, 2000 ~ ~ , '~ ,\ ~:.. > -~ Print numbers in boxes. `~\' ; Month Day <~e~ot birth .. ,..:~ '. NOTE: Please answer BOTH Questions 5 and 6. Is this person Spanish/Hispanic/Latino? Mark the "No" box if not Spanish/Hispanic/Latino. O No, not Spanish/Hispanic/Latino O Yes, Mexican, Mexican Am., Chicano O Yes, Puerto Rican . O Yes, Cuban O Yes, other Spanish/Hispanic/Latino -Prins group. ~ ~ IIIIIIIIIIIIII What is this person's marital status? O Now married O Widowed O Divorced O Separated O Never married a. At any time since February 1, 2000, has this person attended regular school or college? Include only nursery school or preschool, kindergarten, elementary school, and schooling which leads to a high schoo/ diploma or a college degree. O No, has not attended since February 1 --~ Skip to 9 ^ Yes, public school, public college O Yes, private school, private college (1~ Question is asked of all persons on ~ the short (100-percent) and long (sample) forms. ~~ ~ Porm o.e, e