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Women.NYC Network: Intake Questionnaire
Please share a little about yourself!
*
First Name
(Required.)
*
Last Name
(Required.)
*
Email
(Required.)
*
LinkedIn profile (if you do not have a LinkedIn account, please enter "NA".)
(Required.)
*
Zip Code
(Required.)
*
Gender
(Required.)
Female
Male
Non-binary/Third gender
Prefer not to disclose
*
Age
(Required.)
18-24
25-34
35-44
45-54
55-64
65+
Prefer not to disclose
*
Race (Please choose the option that best reflects your identity)
(Required.)
Asian
American Indian or Alaska Native
Black or African American
Native Hawaiian or Pacific Islander
Two or more races
White or Caucasian
Prefer not to disclose
*
Ethnicity
(Required.)
Hispanic or Latino
Not Hispanic or Latino
Prefer not to disclose
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Education
(Required.)
High school or equivalent
Some college
Associate's Degree
Bachelor's Degree
Master's Degree
Doctorate
Professional
Technical or occupational certificate
Prefer not to disclose
*
Which of the following best reflects your total annual income?
Select the income range that most closely applies. This is for internal demographic reporting only and will not be shared.
(Required.)
$0 - $68,039
$68,040 - $90,719
$90,720 - $124,739
$124,740 - $187,109
$187,110+
Prefer not to disclose
*
What is your professional experience level?
Please choose the option that best fits you or your situation.
(Required.)
Intern
Entry Level
Mid-Career
Management
Senior/Experienced Professional
*
Which high growth industry interests you the most?
(Required.)
Tech
Green Economy
Life Sciences
