Demographics 

For NIMH NDA (R34s, R01s) 

Need permission in the consent form to give data to NDA. Ask Methods Core for an example if you don’t have one. 

All of the following information is required: 

• First Name 
• Middle Name 
• Last Name 
• Sex – M = Male; F = Female; O=Other; NR = Not reported 
• Date of Birth dd/mm/year 
• City/Municipality of Birth 

Center-Level Demographics 

What is your age? (in years)

What is your race? (check all that apply)

• American Indian/Alaska Native
• Asian
• Black or African American
• Hawaiian or Pacific Islander
• White
• Another Race (please specify)
• Unknown
• Prefer Not to Answer

What is your ethnicity?

• Hispanic/Latina/o/e
• Not Hispanic/Latina/o/e
• Prefer not to say

What is your gender?

• Female
• Male
• Non-binary
• Transgender
• Prefer not to say
• Prefer to self-describe {gender_self_describe}

What is your highest level of education?

• No schooling completed
• 8th grade
• Some high school, no diploma
• High school graduate or equivalent
• Some college, no degree
• Trade/technical/vocational training
• Associate degree
• Bachelor’s degree
• Master’s degree
• Professional or doctorate
• Prefer not to say

What is your professional role? (e.g. social worker, high school student, etc.)
(open-text)