* 1. Gender

* 2. Age

* 3. Race/Ethnicity (You may check more than one.)

* 4. Where do you live?

* 5. Which versions of the “For Me, For Us” video have you seen? (Check all that apply.)

* 6. How did you find out about this video?

* 7. Do you feel that the information in the video was useful?

* 8. Was the video easy to understand?

* 9. Was the video enjoyable to watch?

* 10. Did you learn any new information by watching this video?

* 11. Were you motivated to change any health behaviors because of watching this video?

* 12. Would you recommend this video to a friend or relative?

* 13. Overall, how do you rate the video?

* 14. Do you have any comments about the video?

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