how do adolescents define depression? - cIRcle - University of ...

APPENDIX C: Demographic Information
ABOUT YOURSELF
Grade^
1. Are you male or female? (circle one)^Male ^ Female
2. What is your birth date? ^
(month) (day)^(year you were born)
3. Which of these adults do you live with MOST OF THE TIME?
(Check all the adults you live with).
Mother^Grandmother ^ 1/2 Mom, 1/2 Dad
Father^Grandfather
Stepfather^Stepmother
Other adults (EXPLAIN, for example, aunt, uncle, mom's
boyfriend, foster parents) ^
4. Do you have any brother(s) in your family? (include stepbrothers)
Yes^No
If yes, how old are they^
5. Do you have any sister(s) in your family? (include stepsisters)
Yes^^ No
If yes, how old are they^
6. What is the first language you learned at home?^
7. Which language(s) do you speak at home?^
8. Which language do you prefer to speak?^
9. How many years have you lived at your current address?
10. What country were you born in?
11. Ethnicity/Race
Appendices
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