PBWHA Adult Needs Assessment Estimated time: 15-20 minutesAll responses are anonymous and confidential. Your feedback will inform PBWHA’s programs, services, and strategic planning. Question Title * 1. What is your email address? Demographic Information Question Title * 2. Age Group (please select one) (Required.) 18–24 25–34 35-44 45-54 55-64 65+ 18–24 25–34 35-44 45-54 55-64 65+ Question Title * 3. Gender identity (select one): (Required.) Woman/Girl Man/Boy Trans Man Trans Woman Non-binary/Non-conforming Prefer not to respond Prefer to Self Identify Question Title * 4. Race / Ethnicity (check all that apply): (Required.) Black / African American Hispanic / Latino / Latinx Asian / Asian American Native American / Alaska Native Native Hawaiian / Pacific Islander Middle Eastern / North African White More than one race Prefer not to say Other (please specify) Question Title * 5. ZIP code: (Required.) Next
