Individual Survey

This is an anonymous survey; there is no way for us to know who you are. By answering the 9 questions  below, we can make sure that we do not get more than one survey from the same person. Please complete all of the following questions. Thank you for taking the time to complete our survey.

* 1. First letter of your last name

* 2. Last 4 digits of your Social Security Number

* 3. What is your zip code?

* 4. What is the name of the town or municipality where you reside?

* 5. What is your ethnicity?

* 6. What is your Race? (Please select one)

* 7. What is your gender?

* 8. What is the primary language spoken in your home?

* 9. How did you receive this survey?