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©ALGA Questionnaire
Demographics
First, please answer some questions about your demographics.
1.
Please indicate your gender
(Required.)
male
female
2.
How old are you?
(Required.)
< 20 years
20-24 years
25-29 years
30-39 years
40-49 years
50-60 years
> 60 years
3.
Have you previously filled out this particular questionnaire?
(Required.)
yes
no
4.
What is your nationality?
(Required.)
American
British
Dutch
German
Italian
Spanish
Other (please specify)
5.
Which country do you live in?
(Required.)
America
Germany
Italy
Netherlands
Spain
UK
Other (please specify)
6.
Please indicate you marital status
(Required.)
single
living with partner, but not married
married
seperated/divorced
widowed
7.
Do you have children?
(Required.)
yes
no