Demographic Section:

This survey is being conducted in Walker County by the Georgia Department of Public Health Northwest District 1-1. The Department of Public Health in partnership with the community leaders and representatives is conducting a comprehensive health assessment in the community. The purpose of this health assessment is to help Walker County become a better and healthier place to live with equal opportunities for all its residents to improve their overall quality of life. The information gathered will be used by the Community Health Assessment Team to identify and address issues of concern for the community and, to identify the resources needed to address them. No names or addresses will be collected or used in this survey. Your participation is voluntary, and all individual answers will be kept private.

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* 1. Zip Code:

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* 2. Age:

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* 3. Gender:

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* 4. Marital Status:

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* 5. What ethnic group do you most identify with?

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* 6. What is the highest level of education you have completed?

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* 7. Please indicate your annual household income category:

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