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MPox Survey
1.
What is your gender?
Female
Male
Other (specify)
2.
Which category below includes your age?
17 or younger
18-20
21-29
30-39
40-49
50-59
60 or older
3.
What is the highest level of school you have completed or the highest degree you have received?
Less than high school degree
High school degree or equivalent (e.g., GED)
Some college but no degree
Associate degree
Bachelor degree
Graduate degree
4.
Which of the following categories best describes your employment status?
Employed, working 40 or more hours per week
Employed, working 1-39 hours per week
Not employed, looking for work
Not employed, NOT looking for work
Retired
Disabled, not able to work
5.
How much total combined money did all members of your HOUSEHOLD earn last year?
$0 to $9,999
$10,000 to $24,999
$25,000 to $49,999
$50,000 to $74,999
$75,000 to $99,999
$100,000 to $124,999
$125,000 to $149,999
$150,000 to $174,999
$175,000 to $199,999
$200,000 and up
Prefer not to answer
6.
Are you White, Black or African-American, American Indian or Alaskan Native, Asian, Native Hawaiian or other Pacific islander, or some other race?
White
Black or African-American
American Indian or Alaskan Native
Asian
Native Hawaiian or other Pacific Islander
From multiple races
Some other race (please specify)
7.
Are you Spanish, Hispanic, or Latino?
Yes
No
Current Progress,
0 of 19 answered