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Copy of Tobacco Retailer Density Survey
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1.
Your age?
(Required.)
17 or younger
18-20
21-29
30-39
40-49
50-59
60 or older
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2.
Have you taken this survey in the past 2 months?
(Required.)
Yes
No
3.
How would you describe yourself?
Female
Male
Prefer not to answer
Other (please specify)
*
4.
Which of the following would you say is your race? (check all that apply)
(Required.)
White
Black or African-American
American Indian or Alaska Native
Asian
Native Hawaiian or Pacific Islander
Prefer not to answer
Other (please specify)
*
5.
Are you Hispanic, Latino/a or Spanish origin?
(Required.)
Yes
No
Prefer not to answer
Current Progress,
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