Projects
Proxy_Survey_1-4.doc
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Proxy Survey
Ask your respondent about every house on the block, including houses you already have collected information about.
Can I ask you a few quick questions about your neighbors?
1. How many people currently live at that house? ______________
2. Age categories:
A. How many children under 5 years of age live there? |
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B. How many school age children from 5 to18 years of age? |
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C. How many adults between 19 to 64 years of age? |
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D. How many elderly adults over the age of 65? |
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3. Is the head of the household a female?
Yes No Don't Know
3.a. if so, is she single?
Yes No Don't Know
4. Is the head of the household employed?
Yes No Don't Know
5. What is the race or ethnicity of the household?
Mixed household
Black or African American
White/Caucasian
Asian
Hispanic
Other, specify_________________
