Literal question
Note: Please answer both Question 5 about Hispanic origin and Question 6 about race. For this survey, Hispanic origins are not races.</p>
<p>5. Is Person X of Hispanic, Latino, or Spanish origin?</p>
<div class="i1">[] No, not of Hispanic, Latino, or Spanish origin <br />[] Yes, Mexican, Mexican Am., Chicano <br />[] Yes, Puerto Rican <br />[] Yes, Cuban <br />[] Yes, another Hispanic, Latino, or Spanish origin - <span class="ital">Print origin, for example, Argentinean, Colombian, Dominican, Nicaraguan, Salvadoran, Spaniard, and so on.</span> - ____</div><p>6. What is Person X's race?</p>
<div class="i1"><span class="ital">Mark (X) one or more boxes and print origins.</span><br /><br />[] White - <span class="ital">Print, for example, German, Irish, English, Italian, Lebanese, Egyptian, etc.</span> - ____<br />[] Black or African Am. - <span class="ital">Print, for example, African American, Jamaican, Haitian, Nigerian, Ethiopian, Somali, etc.</span> - ____<br />[] American Indian or Alaska Native - <span class="ital">Print name of enrolled or principal tribe(s), for example, Navajo Nation, Blackfeet Tribe, Mayan, Aztec, Native Village of Barrow Inupiat Traditional Government, Nome Eskimo Community, etc.</span> - ____<br />[] Chinese<br />[] Filipino<br />[] Asian Indian<br />[] Vietnamese<br />[] Korean<br />[] Japanese<br />[] Other Asian - <span class="ital">Print, for example, Pakistani, Cambodian, Hmong, etc.</span> - ____<br />[] Native Hawaiian<br />[] Samoan<br />[] Chamorro<br />[] Other Pacific Islander - <span class="ital">Print, for example, Tongan, Fijian, Marshallese, etc.</span> - ____<br />[] Some other race - <span class="ital">Print race or origin.</span> - ____</div>