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UNC NEUROLOGY IN NUMBERS
1.
Which category best describes you? Select all that apply
Asian or Asian American
Black or African American
Hispanic or Latino
Middle Eastern or North African
Native American Indian or Alaska Native
Native Hawaiian or other Pacific Islander
White or Caucasian
Prefer not to answer
Other, Self describe below
2.
What is your age group?
18-24
25-34
35-44
45-54
55-64
65+
Prefer not to answer
3.
What is your current gender identity?
Man
Woman
Transgender
Genderqueer
Nonbinary
Prefer not to disclose
Other, Self-describe below:
4.
Do you identify with any of the following religions? (Select all that apply.)
Christianity (Catholic, Protestant or any other Christian denominations)
Buddhism
Hinduism
Islam
Judaism
Native American
Sikh
No religion
Prefer not to answer
Any other religion (Self-describe below)
5.
Are you a person living with a disability?
Yes
No
Prefer not to answer
6.
Are you a parent or caretaker of children?
Yes
No
Prefer not to answer
7.
Are you a caretaker of adults?
Yes
No
Prefer not to answer
8.
Do you consider yourself a first generation college graduate?
Yes
No
Prefer not to answer
9.
Have you ever served on active duty in the U.S. Armed Forces (includes activation from the Reserves or National Guard)?
Yes
No
Prefer not to answer
10.
What is your official employment title? You may opt out of answering this question if you are not comfortable