Community Resident Survey
Exit this survey
1
. Are you:
Are you:
Female
Male
2
. What race/ethnicity do you consider yourself to be?
What race/ethnicity do you consider yourself to be?
White/Caucasian
Black/African American
American Indian
Hispanic/Spanish
Asian
Native American/American Indian
Other (please specify)
3
. What is your current marital status?
What is your current marital status?
Never married
Married
Widowed
Separated
Divorced
4
. What is the intersection (cross streets) nearest your place of residence?
What is the intersection (cross streets) nearest your place of residence?
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