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1
. What is your FIRST and LAST name?
What is your FIRST and LAST name?
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2
. What is the best PHONE number for us to contact you on?
What is the best PHONE number for us to contact you on?
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3
. What is your gender?
What is your gender?
Male
Female
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4
. What is your age?
What is your age?
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5
. Which of the following best describes your ethnic background?
Which of the following best describes your ethnic background?
African American
Asian
Caucasian
Hispanic/Latino
Native American
Other
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6
. Which of the following best describes your marital status?
Which of the following best describes your marital status?
Single
Married or Living with partner
Divorced, Separated, Widowed
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7
. Do you have any children 17 or younger living in your household?
Do you have any children 17 or younger living in your household?
Yes
No
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8
. Which of the following best describes your employment situation?
Which of the following best describes your employment situation?
Employed full-time
Employed part-time
Self-employed
Homemaker
Student
Retired
Not employed
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9
. What is the highest level of education you have had the opportunity to complete?
What is the highest level of education you have had the opportunity to complete?
Some High School or less
High School/GED
Some College
Trade/Technical School
College Graduate
Some Post College
Advanced Degree
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10
. Into which of the following ranges does your annual HOUSEHOLD income fall?
Into which of the following ranges does your annual HOUSEHOLD income fall?
Under $99K
$100K to $149K
$150K to $199K
$200K or more
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11
. Into which of the following ranges does your annual PERSONAL income fall?
Into which of the following ranges does your annual PERSONAL income fall?
Under $30K
$30K to $74K
$75K to $99K
$100K or more
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12
. What industry do you work in?
What industry do you work in?
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