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  2. 2016
  3. March
  4. C
  5. Childhood Depression
0%
Questions marked with a * are required Exit Survey
 
 
* What is your age?
 
18-29 years old
 
30-49 years old
 
50-64 years old
 
65 years and over
 
 
 
What is your gender?
 
Male
 
Female
 
 
 
What is the highest level of education you have completed?
 
some high school
 
high school graduate
 
some college
 
trade/technical/vocational training
 
college graduate
 
some postgraduate work
 
post graduate degree
 
 
 
What is your religious preferences?
 
Christian Scientist
 
Jewish
 
Mormon
 
Roman Catholic
 
an Orthodox church such as the Greek or Russian Orthodox Church
 
Seventh-Day Adventist
 
Muslim
 
Protestant
 
Something else (please specify)
 
Other
 
 
 
 
* Race: What is your race? Are you white, African-American, or some other race?
 
white
 
African-American
 
Other
 
 
 
 
Ethnicity: We want to be sure that we have spoken to a broad mix of people in your area. Are you, yourself, of Hispanic origin or descent, such as Mexican, Puerto Rican, Cuban, or other Spanish background?
 
Yes
 
No
 
 
 
Is your total annual income before taxes $20,000 or more, or is it less than $20,000?
 
Under $20,000
 
Over $20,000
 
 
 
What is your marital status?
 
single/never been married
 
married
 
separated
 
divorced
 
widowed
 
 
 
How many children live in your household who are...
 
Less than 5 years old?
 
5 through 12 years old?
 
13 through 17 years old?

 
 
 
Which of the following most closely matches your job title?
 
Intern
 
Entry Level
 
Analyst / Associate
 
Manager
 
Senior Manager
 
Director
 
Vice President
 
Senior Vice President
 
C level executive (CIO, CTO, COO, CMO, Etc)
 
President or CEO
 
Owner
 
Other