Developing an Effective Website Demographics Survey

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* 1. In what state or U.S. territory is your small business located?

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* 2. In what town is your small business located?

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* 3. In what ZIP code is your small business located? (enter 5-digit ZIP code; for example, 00544 or 94305)

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* 4. What is your gender?

Female

Male

Other (specify)

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* 5. What is your age?

17 or younger

18-20

21-29

30-39

40-49

50-59

60 or older

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* 6. 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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* 7. Are you Mexican, Mexican-American, Chicano, Puerto Rican, Cuban, Cuban-American, or some other Spanish, Hispanic, or Latino group?

I am not Spanish, Hispanic, or Latino

Mexican

Mexican-American

Chicano

Puerto Rican

Cuban

Cuban-American

Some other Spanish, Hispanic, or Latino group

From multiple Spanish, Hispanic, or Latino groups

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* 8. 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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* 9. In what language do you write most often?

English

Spanish

Other (please specify)