United Way of the Titusville Region - Needs Assessment 2014

Demographic Information

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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. Are you male or female?

Male

Female

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* 3. What is your age?

17 or younger

18-20

21-29

30-39

40-49

50-59

60 or older

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* 4. Which of the following best describes your current relationship status?

Married

Widowed

Divorced

Separated

In a domestic partnership or civil union

Single, but cohabiting with a significant other

Single, never married