Demographic Information

50% of survey complete.

This demographic survey is being administered by the Office of Statewide Health Planning and Development (OSHPD) who partially funds your participation in this program. In efforts to collect data that enables the evaluation of the program’s effectiveness towards serving diverse populations, this survey aims to collect data on the wide range of demographics of our program participants. While this survey is optional, OSHPD kindly requests your completion of this anonymous survey.

* 1. Please identify your COUNTY of residence:

* 2. Please identify your Race / Ethnicity (check all that apply):

* 3. Please select any languages you speak in addition to English: