BE A MAN Survey
Exit this survey
1. Stuff about you (p. 1 of 8)
This gives us a few details about you to help us sort the responses we get on the survey.
1
. Please share a few details about yourself with us. None of this information will be shared without your permission.
Please share a few details about yourself with us. None of this information will be shared without your permission.
Name:
City/Town:
State:
-- select state --
AL Alabama
AK Alaska
AS American Samoa
AZ Arizona
AR Arkansas
CA California
CO Colorado
CT Connecticut
DE Delaware
DC District of Columbia
FM Federated States of Micronesia
FL Florida
GA Georgia
GU Guam
HI Hawaii
ID Idaho
IL Illinois
IN Indiana
IA Iowa
KS Kansas
KY Kentucky
LA Louisiana
ME Maine
MH Marshall Islands
MD Maryland
MA Massachusetts
MI Michigan
MN Minnesota
MS Mississippi
MO Missouri
MT Montana
NE Nebraska
NV Nevada
NH New Hampshire
NJ New Jersey
NM New Mexico
NY New York
NC North Carolina
ND North Dakota
MP Northern Mariana Islands
OH Ohio
OK Oklahoma
OR Oregon
PW Palau
PA Pennsylvania
PR Puerto Rico
RI Rhode Island
SC South Carolina
SD South Dakota
TN Tennessee
TX Texas
UT Utah
VT Vermont
VI Virgin Islands
VA Virginia
WA Washington
WV West Virginia
WI Wisconsin
WY Wyoming
ZIP/Postal Code:
Country:
Email Address:
2
. May we have permission to include your name in print or other media when referring to your responses in this survey?
May we have permission to include your name in print or other media when referring to your responses in this survey?
Yes
No
3
. What is your Gender? (hint: this survey is for guys only.)
What is your Gender? (hint: this survey is for guys only.)
Male
Female
4
. How old are you?
How old are you?
under 20 years old
21 to 40
41 to 60
61 or older
5
. How do you identify yourself socially?
How do you identify yourself socially?
Very liberal
Liberal to moderate
Moderate/centrist
Moderate to conservative
Very conservative
6
. Which best describes your current marital status:
Which best describes your current marital status:
Single
In a relationship
Married
Separated
Divorced
Widowed
7
. How many children do you have?
How many children do you have?
none
one
two
three
four
five or more
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