One Small Step Participant Survey Please fill this survey out, so that we can find the best match for a One Small Step conversation. OK Question Title * 1. Contact Information Name Address Address 2 City/Town State -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP/Postal Code Email Address Phone Number OK Question Title * 2. Primary language spoken? English Spanish Other (please specify) OK Question Title * 3. How did you hear about One Small Step? OK Question Title * 4. Preferred method of contact Email Phone OK Question Title * 5. Best time to contact you? (Please specify hours, a.m or p.m.) OK Question Title * 6. Anytime that we should not contact you? OK Question Title * 7. What is your age? 18 to 24 25 to 34 35 to 44 45 to 54 55 to 64 65 to 74 75 or older OK Question Title * 8. What is your gender? Female Male Non-Binary Prefer not to answer OK Question Title * 9. What is your current religion, if any? Christian/Protestant/Methodist/Lutheran/Baptist Catholic Mormon Greek or Russian Orthodox Jewish Muslim Buddhist Hindu Atheist or agnostic Nothing in particular Prefer not to answer Other (please specify) OK Question Title * 10. Which race/ethnicity best describes you? (Please choose only one.) American Indian or Alaskan Native Asian / Pacific Islander Black or African American Hispanic/Latino White / Caucasian Multiple ethnicity / Other (please specify) OK Question Title * 11. Which of the following best describes your current occupation? Healthcare Field Business and Financial Operations Occupations Military/ Government Transportation and Materials Moving Occupations Computer and Mathematical Occupations Architecture and Engineering Occupations Building and Grounds Cleaning and Maintenance Occupations Arts, Design, Entertainment, Sports, and Media Occupations Office and Administrative Support Occupations Management Occupations Food Preparation and Serving Related Occupations Construction and Extraction Occupations Community and Social Service Occupations Life, Physical, and Social Science Occupations Sales and Related Occupations Personal Care and Service Occupations Education, Training, and Library Occupations Legal Occupations Retired Other (please specify) OK Question Title * 12. Do you consider yourself a ... Strong Republican Republican Lean toward Republican Independent/ No party affiliation Lean toward Democrat Democrat Strong Democrat Other OK Question Title * 13. When you consider your political thinking, which of the following best describes you? Consistently liberal Mostly liberal Mixed Mostly conservative Consistently conservative Other (please specify) OK Question Title * 14. Please describe your ideal partner for this conversation (in terms of political ideology, beliefs, etc.) OK Question Title * 15. What do you want to achieve by participating in a conversation with someone who holds a different political viewpoint? (please explain in no more than 3 sentences) OK Question Title * 16. Do you have any concerns about participating in a conversation with someone who holds different political views than your own? (please explain in no more than 3 sentences) OK Question Title * 17. What time of day is best for you to participate? Morning Afternoon Early Evening OK Question Title * 18. Please describe youself, including any details you think a potential conversation partner should know about you. If you are chosen, this short bio will be shared with your conversation partner prior to your discussion together. OK DONE
