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Which gender do you identify?
 
Male
 
Female
 
Prefer not to answer
 
Other
 
 
 
 
What is your age?
 
Under 12 years old
 
12-17 years old
 
18-24 years old
 
25-34 years old
 
35 or older
 
 
 
What is your Ethnicity origin? (If multiracial, please select "other" and clarify)
 
 
 
What generation are you?
 
First generation in America
 
Second generation in America
 
Third generation in America
 
Fourth or more
 
 
 
What is your current employment status?
 
Employed for wages
 
Self-employed
 
Out of work and looking for work
 
Out of work but not currently looking for work
 
A homemaker
 
A student
 
Military
 
Retired
 
Unable to work
 
 
 
Do you feel inadequate about not "living up to" the image of (academic) excellence that others seem to expect of you? If yes, please explain.
   
 
 
 
Do others seem surprised when you "stand up for yourself" or express dissatisfaction about a situation? If yes, please explain.
   
 
 
 
Do professors and classmates assume that you study all the time? If yes, please explain.
   
 
 
 
Do college peers express envy or resentment that you "probably get A's all the time", and assume that you are academically gifted? If yes, please explain.
   
 
 
 
Have you, a friend, or a family member ever experienced racially based harassment in school or in the workplace? If yes, please explain.