Demographic Survey

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* 1. What is your gender?

Male

Female

Trans-gender

Prefer not to answer

Other (please specify)

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* 2. What is your age?

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* 3. Do you identify as Hispanic or Latino

Yes

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* 4. Ethnicity/Race. Select all that apply.

White or Caucasian

Black or African American

Asian or Asian American

Native American or Alaska Native

Native Hawaiian or other Pacific Islander

Other (please specify)

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* 5. Where do you currently reside?

City/Town

State/Province

ZIP/Postal Code

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* 6. Do you have any chronic conditions?

Yes

Please specify -

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* 7. Which of the following do you have? Select all that apply.

Medicaid

Medicare Part A

Medicare Part B

Medicare Part C

Medicare Part D

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* 8. On a scale 1-10, how comfortable are you with technology? (1 being very uncomfortable, 10 being comfortable).
For example: navigating the computer, using your phone, using zoom.

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 9. On a scale of 1-10, how satisfied are you with RetireSafe’s services? (1 being very unsatisfied, 10 being extremely satisfied)

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 10. Would you be interested in attending virtual events held by RetireSafe?

Yes

If Yes, please enter your email address

Demographic Survey

Question Title

* 1. What is your gender?

Question Title

* 2. What is your age?

Question Title

* 3. Do you identify as Hispanic or Latino

Question Title

* 4. Ethnicity/Race. Select all that apply.

Question Title

* 5. Where do you currently reside?

Question Title

* 6. Do you have any chronic conditions?

Question Title

* 7. Which of the following do you have? Select all that apply.

Question Title

* 8. On a scale 1-10, how comfortable are you with technology? (1 being very uncomfortable, 10 being comfortable). For example: navigating the computer, using your phone, using zoom.

Question Title

* 9. On a scale of 1-10, how satisfied are you with RetireSafe’s services? (1 being very unsatisfied, 10 being extremely satisfied)

Question Title

* 10. Would you be interested in attending virtual events held by RetireSafe?

* 8. On a scale 1-10, how comfortable are you with technology? (1 being very uncomfortable, 10 being comfortable).
For example: navigating the computer, using your phone, using zoom.