Act One Culture Pass Survey

Thank you for using the Culture Pass.

The Culture Pass program is a joint project of Act One, the partner libraries and and the participating arts organizations. We appreciate your participation in our survey and value your input. Your personal data will not be shared or individually compiled. If you prefer to fill out a printed survey, you can download it at www.act1az.org/survey

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

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* 2. What is your email address? *Will only be used for Culture Pass/Act One information. Will not be shared.

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* 3. How many adults (18+) live in your household?

18-24

25-33

34-44

45-54

55-64

65+

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* 4. How many children, by age, currently live in your household? Leave blank if no children live in your household.

0-3 years

4-8 years

9-13 years

14-17 years

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* 5. What was your household income last year?

$0-$16,000

$16,001-20,000

$20,001 - $25,000

$25,001 - $33,000

$33,001 - $50,000

$50,001-$75,000

$75,001 - $100,000

More than $100,001

Prefer not to disclose. Please note that this information will not be linked directly to you.

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* 6. What is your ethnicity? (Please select all that apply.)

American Indian or Alaskan Native

Asian or Pacific Islander

Black or African American

Hispanic or Latino

White / Caucasian

Prefer not to answer

Other (please specify)

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* 7. What is the highest level of education you have completed?

Did not graduate high school

Graduated from high school or earned a GED

Some college but did not graduate

Associates Degree

Bachelors degree

Masters degree

Doctoral degree

Prefer not to answer

I am a student currently attending (please fill in the blank i.e. name of high school or college)

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* 8. Are you, or is someone in your household, a veteran or currently serving in the military?

Yes

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* 9. How did you learn about the Culture Pass?

My local library

Act One website

Friend or family member

TV or newspaper

My child's field trip

Other (please specify)

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* 10. In what county did you check out your Culture Pass?

Maricopa County or Pinal County (Phoenix metropolitan area)

Pima County (Tucson metropolitan area)

Yavapai County (Sedona)