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The following information is confidential and for research purposes only.

1. Are you male or female?

2. Which category below includes your age?

3. What is the highest level of school you have completed or the highest degree you have received?

4. Which of the following categories best describes your employment status?

5. How much total combined money did all members of your HOUSEHOLD earn in 2012? This includes money from jobs; net income from business, farm, or rent; pensions; dividends; interest; social security payments; and any other money income received by members of your HOUSEHOLD that are EIGHTEEN (18) years of age or older.

6. Are you White, Black or African-American, American Indian or Alaskan Native, Asian, Native Hawaiian or other Pacific islander, or some other race?

* 7. In what city do you live?