Bodega Demographics Survey

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* 1. How do you currently describe your gender identity? Please specify, or state "I prefer not to answer."

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* 2. What is your age in years? Please specify, or state "I prefer not to answer."

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* 3. Which categories describe you? Select all that apply to you:

American Indian or Alaska Native—for example Navajo Nation, Blackfeet Tribe, Mayan, Aztec, Dakota Tribe, Ojibwe/Anishinabe, Nome Eskimo Community

Asian—For example, Chinese, Filipino, Asian Indian, Vietnamese, Korean, Japanese

Black or African American—For example, Jamaican, Haitian, Nigerian, Ethiopian, Somali

Hispanic, Latino or Spanish Origin—For example, Mexican or Mexican American, Puerto Rican, Cuban, Salvadoran, Dominican, Columbian

Middle Eastern or North African—For example, Lebanese, Iranian, Egyptian, Syrian, Moroccan, Algerian

Native Hawaiian or Other Pacific Islander—For example, Native Hawaiian, Samoan, Chamorro, Tongan, Fijian, Marshallese

White—for example, German, Irish, English, Italian, Polish, French

I prefer not to answer

Some other ethnicity or origin (please specify)

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* 4. Which categories describe you? Select all that apply to you:

Some high school

High school diploma or equivalent

Vocational training

Some college

Associate’s degree (e.g., AA, AE, AFA, AS, ASN)

Bachelor’s degree (e.g., BA, BBA, BFA, BS)

Some post undergraduate work

Master’s degree (e.g., MA, MBA, MFA, MS, MSW)

Specialist Degree (e.g., EdS)

Applied or professional doctorate degree (e.g., MD, DDC, DDS, JD, PharmD)

Doctorate degree (e.g., EdD, PhD)

Other (please specify)

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* 5. Where do you live? If MN, give town or city and county, if elsewhere, please specify.

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* 6. Do you have a long-lasting or chronic condition (physical, visual, auditory, cognitive or mental, emotional, or other) that substantially limits one of more of your major life activities (your ability to see, hear, or speak; to learn, remember, or concentrate; work or engage in social activities?)

Yes

I prefer not to answer

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* 7. If yes, is there anything we could make it easier for you to participate in our programs and activities?

Thank you for taking time to complete this survey. Demographic data helps our funding and program planning, and enables us to evaluate how well we are achieving our mission to support diversity and foster community. We value your participation.