Living with XXY

You are making a difference

This survey is designed to help us learn more about our community, create more useful resources, and continue building our community all over the world. Your information is always kept confidential. Thank you for participating.

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* 1. First name

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* 2. Last name

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* 3. Street address

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* 4. City

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* 5. State/province

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* 6. Zip/postal code

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* 7. What is your email address?

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* 8. What is your birthday?

Enter below

Date

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* 9. Ethnicity

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* 10. What is your gender?

Male

Female

Prefer not to answer

Other (please specify)

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* 11. What is your marital status?

Married or cohabiting

Single

Divorced or separated

Other (please specify)

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* 12. Do you have children?

Yes, I have ______ children.
Please enter the number of children you have.

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* 13. What levels of education you have completed?

High school

Associate's degree

Certificate Program

Bachelor's degree

Graduate degree

Professional degree

Trade school (please specify)

None of the above

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* 14. What is your occupation?

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* 15. Who in your life has XXY?

I do

My partner or spouse

My child

A family member

I have a different X and Y variation than XXY (i.e XYY, XXXY, etc)

Parent of child with a different X and Y variation than XXY (i.e XYY, XXXY, etc)