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DriverHEALTH Survey
1. Demographics
1 / 9
1
. Gender
Gender
Male
Female
2
. What's Your Age?
What's Your Age?
21-29
30-44
45-59
Over 60
3
. Marital Status?
Marital Status?
Single/Widowed
Divorced
Married
4
. If You Answered “Married” to Question 3, is Your Spouse Employed?
If You Answered “Married” to Question 3, is Your Spouse Employed?
Yes
No
5
. Do You Have Children Living at Home?
Do You Have Children Living at Home?
Yes
No
6
. What is Your Current Level of Education?
What is Your Current Level of Education?
I did not graduate high school
GED
High School Graduate
Some College
2 year/Associates Degree
College Graduate
Post-College
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