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What is your gender?
 
Male
 
Female
 
 
 
What is your marital status?
 
Single (Never married)
 
Married
 
Domestic partnership
 
Widowed
 
Divorced
 
Separated
 
Don’t know
 
 
 
What is your age?
 
Younger than 18
 
18 - 24
 
25 - 34
 
35 - 44
 
45 - 54
 
55 - 64
 
65 or older
 
Prefer not to answer
 
 
 
What is the highest level of education you have achieved?
 
Less than high school degree
 
High school degree or equivalent (e.g. GED)
 
Some college but no degree
 
Associate degree (e.g. AA, AS)
 
Bachelor's degree (e.g. BA, AB, BS)
 
Master's degree (e.g. MA, MS, MBA)
 
Professional degree (e.g. MD, DDS, JD)
 
Doctorate degree (e.g. PhD)
 
 
 
How many children do you have?
 
No Children
 
1 child
 
2 children
 
3 children
 
More than 3 children
 
 
How old are your children?
less than 1 year 1-2 years 2-5 years 6-9 years 10-12 years 13-15 years 16-18 years 19 or older
Male
Female
 
 
 
How long did you delay coming to the shelter?
 
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