1.Gender

Female

Male

Prefer not to say

Other (please specify)

2.Race

American Indian or Alaska Native

Asian or Asian American

Black or African American

Middle Eastern or North African

Native Hawaiian or other Pacific Islander

White

Other (please specify)

3.Ethnicity

Hispanic/Latino(a)

Non-Hispanic/Latino(a)

4.Age

Under 18

18-24

25-34

35-44

45-54

55-64

65+

5.Education

Some High School

High School Diploma/GED

Some College/Trade School

Bachelor's Degree

Advanced Degree

6.What is your zip code?

7.Do you have a disability?

Yes, I have a disability

No, I do not have a disability

8.How would you rate the health of Menard County?

Very healthy

Healthy

Fairly healthy

Not very healthy

Unhealthy

9.What is ONE thing you think should be done to improve the health of Menard County?

10.Please select the top 3 most serious health issues in Menard County from the following options:

Chronic Respiratory Disease (e.g. asthma, COPD)

Access to Healthcare

Mental Health

Substance Abuse

Motor Vehicle Accidents