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* 1. What is your name?

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* 2. What is the best phone number for us to contact you on?

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* 3. What is your gender?

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* 4. What is your age?

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* 5. Which of the following best describes your ethnic background?

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* 6. Which of the following best describes your marital status?

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* 7. Do you have any children 17 or younger living in your household?

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* 8. Which of the following best describes your employment situation?

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* 9. What is the highest level of education you have had the opportunity to complete?

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* 10. Into which of the following ranges does your annual household income fall?

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* 11. What industry do you work in?

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