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Exit Survey
 
 
In what state do you live?
 
Alabama
 
Alaska
 
Arizona
 
Arkansas
 
California
 
Colorado
 
Connecticut
 
Delaware
 
Florida
 
Georgia
 
Hawaii
 
Idaho
 
Illinois
 
Indiana
 
Iowa
 
Kansas
 
Kentucky
 
Louisiana
 
Maine
 
Maryland
 
Massachusetts
 
Michigan
 
Minnesota
 
Mississippi
 
Missouri
 
Montana
 
Nebraska
 
Nevada
 
New Hampshire
 
New Jersey
 
New Mexico
 
New York
 
North Carolina
 
North Dakota
 
Ohio
 
Oklahoma
 
Oregon
 
Pennsylvania
 
Rhode Island
 
South Carolina
 
South Dakota
 
Tennessee
 
Texas
 
Utah
 
Vermont
 
Virginia
 
Washington
 
Washington, D.C.
 
West Virginia
 
Wisconsin
 
Wyoming
 
Other
 
 
 
 
Are you male or female?
 
Male
 
Female
 
 
 
Which category below includes your age?
 
17 or younger
 
18-20
 
21-29
 
30-39
 
40-49
 
50-59
 
60 or older
 
 
 
Are you now married, widowed, divorced, separated, or never married?
 
Married
 
Widowed
 
Divorced
 
Separated
 
Never married
 
 
 
How many children age 17 or younger live in your household?
   
 
 
 
What is the highest level of school you have completed or the highest degree you have received?
 
Less than high school degree
 
High school degree or equivalent (e.g., GED)
 
Some college but no degree
 
Associate degree
 
Bachelor degree
 
Graduate degree
 
 
 
Which of the following categories best describes your employment status?
 
Employed, working 1-39 hours per week
 
Employed, working 40 or more hours per week
 
Not employed, looking for work
 
Not employed, NOT looking for work
 
Retired
 
Disabled, not able to work
 
 
 
What is your total household income?
 
Less than $20,000
 
$20,000 to $34,999
 
$35,000 to $49,999
 
$50,000 to $74,999
 
$75,000 to $99,999
 
$100,000 to $149,999
 
$150,000 or More
 
 
 
To which racial or ethnic group(s) do you most identify?
 
White
 
Black or African-American
 
American Indian or Alaskan Native
 
Asian
 
Native Hawaiian or other Pacific Islander
 
From multiple races
 
Some other race
 
 
 
 
How often do you participate in fitness activity?
 
Once a week
 
Twice a week
 
3 times a week
 
4 times a week
 
5 times a week
 
6 times a week
 
7 times a week
 
Once a month
 
Once every 3 months
 
Rarely