Residence: (Check only one)
farm or ranch
acreage
town, under 1,000 population
town, 1,000 - 5,000 population
town, 5,000 - 10,000 population
city 10,000 - 20,000 population
city over 20,000 population

Education: (Check only one)
less than 12th grade
completed high school/GED
post secondary education - # of years:

Occupation: (Check only one)
full-time homemaker
full-time work - outside home
part-time work - outside home
farm/ranch partner
small home business owner
retired

Age Category:
under 25
25 - 30
31 - 40
41 - 50
51- 60
61+