Demographics

Are you

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* 1. Are you

What is your age?

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* 2. What is your age?

Who are you filling this out for?

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* 3. Who are you filling this out for?

My zip code is:

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* 4. My zip code is:

How many people currently live in your household?

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* 5. How many people currently live in your household?

Do you have children?  

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* 6. Do you have children?  

How many children are you a parent of or guardian for and live in your household (aged 18 or younger only)?

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* 7. How many children are you a parent of or guardian for and live in your household (aged 18 or younger only)?

Which of the following categories best describes your employment status?

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* 9. Which of the following categories best describes your employment status?

If applicable, which of the following categories best describes your spouse's employment status?

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* 10. If applicable, which of the following categories best describes your spouse's employment status?

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