NAME:_ _ _ _ _ _ _ _ __ SSN: _ _ _ _ _ _ __ CB 116 Follow Up
1. Did you attended a college or university in Fall 20091 0 Yes 0 No
If yes, please indicate the name and location of the institution.
Name of Institution:
\-1_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _...........11
State: I - ­
_ _ _ _ _ _....J
2. Were you employed and/or in the military in Fall 20091 (Fall=October, November or
December 2009)1 0 Yes 0 No
3. Were you self-employed in Fall 20091 0 Yes
4. Other status (if applicable): (0
0 No
=Deceased, I = Incarcerated, a =Other)
1
1
5. THIS SECTION IS OPTIONAL
What is your job title?
Name of Employer:
Location:
Telephone:
I
~--------------------~
What is your current salary/earning? $
---li per 1'---_--'
L - -_ _