West Kitsap Way Planning Study; Online Open House

Voluntary Title VI Demographics Survey

Title VI of the Civil Rights Act of 1964 prohibits discrimination based on race, color, or national origin (including people with Limited English Proficiency) in programs or activities receiving federal financial assistance. Our annual reporting requires the City of Bremerton gather statistical data on participants and beneficiaries of the agency's federal aid highway programs and activities. The City of Bremerton collects demographic information of attendees of public meetings to ensure inclusion of all segments of the population affected by a proposed project.

The City of Bremerton wishes to clarify that this information gathering process is completely voluntary and that you are not required to complete this survey to participate in this meeting.

The City of Bremerton is required to comply with the Public Records Act Chapter 42.56 RCW. As such, the information submitted may ultimately be subject to disclosure as a public record.

The completed surveys will be held on file in the City of Bremerton's Department of Public Works, Engineering Division.

Question Title

* 1. What is your gender identity?

Female

Male

Non-binary or non-conforming

Perfer not to disclose

Another identity (please specify)

Question Title

* 2. Are you living with a disability?

Yes

Prefer not to disclose

Question Title

* 3. How do you describe your racial identity or ethnic heritage? (Check as many as apply)

Alaska Native, Native American, or Indigenous

Asian or Asian American

Black, African American, or African

Native Hawaiian or Pacific Islander

North African, Middle Eastern, or Arabic

White or European

I prefer not to answer

Another identity (please specify)

Question Title

* 4. Do you identify as Hispanic or Latino/a/e

Yes

Question Title

* 5. What language do you primarily speak at home? (select one)

Arabic

Cantonese

English

German

Khmer

Korean

Mandarin

Russian

Spanish

Tagalog

Vietnamese

I prefer not to answer

Something else (please specify)

Question Title

* 6. How old are you?

Under 18

18-24

25-34

35-44

45-54

55-64

65-74

75+

Prefer not to disclose

Question Title

* 7. What is your approximate average household income

Less than $25,000

Between $25,000 and $49,999

Between $50,000 and $74,999

Between $75,000 and $99,999

Between $100,000 and $124,999

Between $125,000 and $149,999

Between $150,000 and 174,999

Between $175,000 and $199,999

$200,000 and up