*1.Where do you live?(Required.)

Hopewell

Prince George

Chester

Colonial Heights

Petersburg

Other (please specify)

*2.What is your age?(Required.)

Under 14

14-18

19-24

25-30

31-39

40-59

60 -75

76+

*3.What is your race or ethnicity? (Please select all that apply.)(Required.)

American Indian or Alaska Native

Asian

Black or African American

Hispanic or Latino

Middle Eastern

White

Other (please specify)

*4.What is your estimated annual household income?(Required.)

Less than $20,000

$20,000-$30,000

$30,000-$40,000

$40,000-$50,000

$50,000-$70,000

$70,000-$90,000

$90,000-$120,000

$120,000-$250,000

$250,000 or more

*5.Are you active duty military or the family of active duty military?(Required.)

Yes

No 

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