1.Please fill out the following information so we may contact you.

Name

City/Town

State/Province

Email Address

Phone Number

2.Which of the following best describes the area where you live? 

Urban

Suburban

Small town or rural

3.What is your age?

4.What is your gender?

Male

Female

Other (please specify)

5.What is your current employment status?

Employed Part Time

Employed Full Time

Gig worker, freelancer

Homemaker/Stay-at-home parent

Student

Retired

Unemployed, looking for work

Unemployed, not looking for work (and not student)

6.How would you describe yourself? Please select all that apply.

White or Caucasian

Black or African American

Hispanic, Latino, or Spanish origin

Asian or Asian Indian

American Indian, Indigenous, or Alaska Native

Middle Eastern or North African

Native Hawaiian or Other Pacific Islander

Other (please specify)

7.Which of the following best describes your annual household income before taxes?

Less than $30,000

$30,000 - $44,999

$45,000 - $54,999

$55,000 - $74,999

$75,000 - $99,999

$100,000 - $149,999

$150,000 - $199,999

$200,000 or more

8.What type of phone do you use most often for personal use that has active cellular service?

Apple iPhone

Google Nexus/Pixel

LG

Motorola

Nokia

Samsung Galaxy

Sony

Other (please specify)