About You and Your Family

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1. City of Residence:

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2. What is your zip code?

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3. What is your role (please check all that apply)?

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4. County of Residence: 

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5. I was born in:

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6. My highest level of education is:

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7. What is your race?

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8. What is your ethnicity?

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9. What is your gender?

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10. Are you are Veteran/active military?

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11. The number of people in my household, including myself is:

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12. I am registered to vote.

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13. What is your marital status?

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14. I am currently single, head of household and live with children under age 18.

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