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What is your gender?
 
Male
 
Female
 
 
 
What is your age?
 
Under 10
 
10-15
 
15-20
 
20-30
 
30-40
 
40-50
 
50-60
 
60 or above
 
 
 
What is your race?
 
White
 
Hispanic
 
African American
 
Asian
 
Native American
 
Other (Specify):
 
 
 
What is your income?
 
Under $20,000
 
$20,000-50,000
 
$50,000-80,000
 
$80,000-100,000
 
$100,000 or above
 
 
 
Education (Highest level completed)
 
Grade School
 
Junior High
 
High School
 
Some College
 
College (Bachelor's Degree)
 
College (Master's Degree)
 
 
 
What is your occupation?
 
Student
 
Homemaker
 
Healthcare
 
Teacher
 
Farming
 
Law Enforcement
 
Other (Specify)
 
 
 
What is your sexual orientation?
 
Straight
 
Homosexual
 
Bi-Sexual
 
Other
 
 
 
What is your marital status?
 
Single
 
Married
 
Divorced
 
Separated
 
Domestic Partnership
 
 
 
What region of the United States do you reside?
 
East Coast
 
West Coast
 
Midwest
 
Southern States
 
Mountain Region
 
 
 
Are you employed?
 
Recently laid off
 
Part time
 
Full time
 
Unemployed
 
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