1. Demographics

Please answer whichever questions you feel comfortable answering. None of this information will be shared or sold without your permission.

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* 1. First Name

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* 2. Last Name

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* 3. Email addresses:

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* 4. Phone numbers:

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* 5. Address

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* 6. City

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* 8. Zip

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* 9. Birthdate

Date / Time

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* 10. What is your gender?

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

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* 12. How much total combined money did all members of your HOUSEHOLD earn last year?

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

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

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* 15. Which of the following best describes your current occupation?

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33% of survey complete.

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