INITIAL
INTERVIEW
QUESTIONNAIRE
 
Today's
Date:                                     9/3/2010
What county do you live in?
 Alamance  Harnett  Person
 Caswell  Hoke  Robeson
 Chatham  Johnston  Sampson
 Cumberland  Lee  Scotland
 Durham  Lenoir  Vance
 Edgecombe  Moore  Wake
 Franklin  Nash  Warren
 Granville  Northhampton  Wayne
 Greene  Orange  Wilson
 Halifax  
Other:
 
 
Name:
 
Are you married?  Yes  No
If so, are you separated?  Yes  No
 
How many children do you have?
How old are your children?
 
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