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Lincoln County Substance Use Community Survey
4.
Demographics
*
1.
What is your 5 digit zip code
(Required.)
54452
54435
54442
54564
54532
54487
Other (please specify)
2.
Which of the following best represents your current occupation?
Healthcare / Treatment Provider
Education / Teacher / Professor
Small Business Owner
Student / Youth
Law / Criminal Justice
Broadcasting / Media / Social Media
Social Services / State / Local / Tribal Govt.
Religious Organization
Youth Serving Agency / Childcare
Skilled Labor / Agriculture
Service Industry / Retail / Food Service
Retired
Unemployed
Other (please specify)
3.
What is your highest level of education?
Some high school
High school diploma, GED, or other equivalent
certificate
Some College
Associate's degree
Bachelor's degree
Master's degree
Doctorate degree
4.
What is your estimated household income including all sources before taxes?
Less than $10,000
$10,000 to $19,999
$20,000 to $29,999
$30,000 to $39,999
$40,000 to $49,999
$50,000 to $59,999
$60,000 to $69,999
$70,000 to $79,999
$80,000 to $89,999
$90,000 to $99,999
$100,000 to $149,999
$150,000 or more
Prefer not to answer
5.
Including yourself, how many people currently live in your household?
6.
Do you currently have health insurance?
Yes
No
7.
Which category best describes you? Select all that apply.
American Indian or Alaska Native
Asian
Black or African American
Hispanic, Latino, or Spanish
Middle Eastern or North African
Native Hawaiian or Other Pacific Islander
White
Other
8.
Which sex was assigned to you at birth?
Female
Male
Other
Prefer not to answer
9.
Are you currently enrolled in Medicare/Badgercare?
Yes
No
10.
What is your sexual orientation?
Heterosexual (straight)
Homosexual (lesbian/gay)
Bisexual
Transgender
Unsure
Other
prefer not to answer
11.
How old are you?
Under 18
18-24
25-34
35-44
45-54
55-64
65+
Current Progress,
0 of 35 answered
