This survey takes about eight minutes to complete, and the answers will be kept completely anonymous. Please submit only one survey per household. Questions may be directed to Wendy Thomas Russell, at www.wendythomasrussell.com.

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1. What is your gender?

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2. How old are you?

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4. How would you best describe your community?

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5. What is your race? (Please check all that apply)

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6. What is your line of work?

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7. What is your annual household income?

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8. What is your relationship status?

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9. How many children do you have?

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10. How old is your eldest child?

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11. Which of the following statements most closely matches your world view?

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12. If your child has more than one parent, which of the following best describes your situation?

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13. What is the predominant religion in the community where you now live? Please be as specific as possible. If you don't know, you may leave this answer blank.

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