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1. How old are you? (Required.)

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2. What is the highest level of school you have completed or the highest degree you have received? (Required.)

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3. Which of the following categories best describes how you identify yourself? (Check all that apply)

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4. What best describes your household income? (Required.)

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5. What is your current marital/dating status? (Required.)

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6. Do you have or plan to have children?

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7. How do you like to spend your free time? (Check all that apply)

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8. In the last 3 - 4 months (answer a & b)

A) What issue or concern has kept you up at night? Check all that apply.
 (Required.)

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9. What are you willing to invest? (answer a & b)

A) If you could receive support in one area of your life right now, what would it look like?
B) If money wasn’t an option, how could I best support you?

 (Required.)

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10. Describe your social media habits (answer a, b & c).

A) What three websites do you visit most frequently?
B) What magazines do you read?
C) How do you prefer to receive information (in person, Facebook, Twitter, Pinterest, books, audio, etc…)?
 (Required.)

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