U.S. Demographics - Snapshot Template

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* 1. Are you male or female?

Male

Female

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* 2. Which category below includes your age?

17 or younger

18-20

21-29

30-39

40-49

50-59

60 or older

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* 3. What is the highest level of school you have completed or the highest degree you have received?

Less than high school degree

High school degree or equivalent (e.g., GED)

Some college but no degree

Associate degree

Bachelor degree

Graduate degree

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* 4. Are you White, Black or African-American, American Indian or Alaskan Native, Asian, Native Hawaiian or other Pacific islander, or some other race?

White

Black or African-American

American Indian or Alaskan Native

Asian

Native Hawaiian or other Pacific Islander

From multiple races

Some other race (please specify)

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

Employed, working 1-39 hours per week

Employed, working 40 or more hours per week

Not employed, looking for work

Not employed, NOT looking for work

Retired

Disabled, not able to work

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* 6. How much money did YOU personally earn in 2010? This includes money from jobs; net income from business, farm, or rent; pensions; dividends; interest; social security payments; and any other money income received by YOU. Please report the total amount of money you earned - do not subtract the amount you paid in taxes or any deductions listed on your tax return.

$0 - $9,999

$10,000 - $19,999

$20,000 - 29,999

$30,000 - $39,999

$40,000 - $49,999

$50,000 - $59,999

$60,000 - $69,999

$70,000 - $79,999

$80,000 - $89,999

$90,000 - $99,999

$100,000 or More