Skip to content
Hamtramck Health Center Community Health Needs Assessment 2018
Background Information
1.
What is your sex?
Male
Female
Other
2.
What is your gender identity?
Male
Female
Transgender
Other
I don't know
Prefer not to answer
3.
What is your sexual orientation?
Straight
Lesbian/Gay
Bisexual
Other
I don't know
Prefer not to answer
4.
How old are you?
14-24
25-34
35-44
45-54
55-64
65+
5.
What is your race/ethnicity? (Please check all that apply)
African American/Black
Asian
Caucasian/White
Hispanic/Latino
Middle Eastern
Other (please specify)
6.
What language do you mainly speak at home?
English
Arabic
Bengali
Polish
Serbo-Croatian
Other (please specify)
7.
What is your current zip code?
48202
48203
48211
48212
48234
Other (please specify)
8.
How are you involved in the community of Hamtramck? (Please check all that apply)
I live in Hamtramck
I am a student in Hamtramck
I work in Hamtramck
Other (please specify)
9.
What is the highest level of school have you completed?
Less than high school
High school graduate/GED
Some college (no degree)
Associate degree
Bachelor's degree
Graduate/professional degree
10.
What is your employment status? (Please check all that apply)
Employed full-time
Employed part-time
Unemployed
Cannot work due to disability
Retired
Student
Homemaker
Other (please specify)
11.
What is your annual income?
Less than $20,000
$20,000-$25,000
$26,000-$38,000
$39,000-$50,000
$51,000-$63,000
Above $63,000
Prefer not to answer