Cancer Consortium Demographic Survey

This survey will take no more than 5 minutes to complete. Data will be reported to others only in aggregate form such that no individual can be identified. Individual identifying data will only be visible to the Associate Director of Faculty Development (Dr. Christopher Li), Office of Faculty Development admin, and Cancer Consortium admin. If you have any questions or concerns related to this survey please reach out to ofad@fredhutch.org.

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* 1. At which institution is your primary appointment?

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* 2. What is your first name?

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* 3. What is your last name?

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* 4. What is your email address?

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* 5. Please select what best describes you...

English is my primary or preferred language

My primary, preferred, and/or native language is.. (please specify)

Decline to answer

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* 6. Which of the following describe you? (check all that apply):

I was born in the U.S. and territories

I was born a U.S. citizen outside of the U.S. and territories

I immigrated to the U.S. and territories

I'm a naturalized U.S. citizen

I'm a permanent resident

Decline to answer

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* 7. Which categories describes you? (Please check all that apply)

African, African-American, or Black: A person having origins in any of the black racial groups of Africa or the Caribbean

American Indian or Native Alaskan: A person having origins in any of the original peoples of North
and South America (including Central America). For example Blackfeet tribe, Cherokee Nation.

Arab American, Middle Eastern, North African

East Asian or Asian-American: A person having origins in any of the original peoples of East Asia including, for example, China, Japan, Mongolia, North Korea, South Korea, and Taiwan

South Asian or Asian American: a person having origins in any of the original peoples of South Asia including, for example, Indian, Afghanistan, Iran, Nepal, Pakistan, Sri Lanka, Maldives, and Bangladesh

Southeast Asian or Asian American: a person having origins in any of the original peoples of Southeast Asia including, for example, Brunei, Burman, Cambodia, Indonesia, Laos, Malaysia, the Philippines, Singapore, Thailand, and Vietnam

Hispanic or Latina/o: A person of Cuban, Mexican, Puerto Rican, or South or Central American, or other
culture or origin

Native Hawaiian or Pacific Islander: A person having origins
in any of the original peoples of Hawaii, Guam, Samoa,
or other Pacific Islands

White: A person having origins in any
of the original peoples of Europe

Multi racial: A person consisting of 2+ ethnicities

Decline to answer

Not listed (please specify)