Indiana Civil Rights Commission's 2013 Perception Survey
Exit this survey

1. Demographic Information

Please complete the following page. If you are not comfortable with disclosing this information you do not have to answer.

1. Are you male or female?

Are you male or female? Male

Female

2. What is your age?

What is your age? 18-21

22-25

26-30

31-40

41-50

51-60

61 or over

3. What is your race/ethnicity?

What is your race/ethnicity? White, non-Hispanic

Hispanic

African American

Asian-Pacific Islander

Native American

Other

4. What city do you live in?

What city do you live in?

Powered by SurveyMonkey

Check out our sample surveys and create your own now!

form {display:none;} #jserror {text-align:center;margin-top:50px;}Javascript is required for this site to function, please enable.