11% of survey complete.

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* 1. Full Name

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* 2. E-Mail Address

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* 3. Phone number to reach you

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* 4. [OPTIONAL] What is your age?

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* 5. Where do you live?

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* 6.  What is your current employment status?

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* 7. Which of the following best describes your ethnic background?

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* 8. What is the highest level of education you have completed?

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* 9. Which of the following best describes your household family composition?

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* 10. What is your annual household income before taxes?

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* 11. What best describes your location?

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* 12. Please indicate how many of the following people live in your household, and what their relationship to you is:

  0 people 1 people 2+ people
Adult roommate (age 18+)
Adult significant other (age 18+)
Other adult age 18+ (e.g. parent, sibling, etc.)
Child under 17 or younger

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* 13. What is your country of birth?

T