For the remaining questions, please circle only one answer.

Age Range: 18 – 22 23 - 30 31 – 40 41 – 50 51 – 60 60+

Gender: Female Male

Ethnicity:

Native American Asian African American Caucasian

Hispanic Other:_________________

Marital Status:

Single Married Widowed Divorced

APPENDIX B

INSTITUTIONAL REVIEW BOARD NOTICE OF COMMITTEE ACTION (initial request for pre-test)

APPENDIX C

INSTITUTIONAL REVIEW BOARD NOTICE OF COMMITTEE ACTION (Amendment request for full study)

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