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First Name : 
Last Name : 
 
 
 
What are your email address ?(This email id will be used to send you the final report of this project. This is an optional field, you may choose not to share your email address with us.)
   
 
 
 
In what country do you currently reside?
 
India
 
Other
 
 
 
 
What is your gender?
 
Male
 
Female
 
 
 
What is your marital status?
 
Married
 
Single (Never 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
 
 
 
Please describe your current residence:
 
Owned by you or someone in household with a mortgage or loan
 
Owned by you or someone in household free and clear (no mortgage or loan)
 
Rented
 
Occupied without payment of rent
 
 
 
Which of the following categories best describes the industry you work in?
 
Automotive
 
Advertising
 
Consulting Services
 
Education
 
Entertainment
 
Financial Services
 
Government Services
 
Healthcare
 
Human Resources
 
Information Technology
 
Marketing/Sales
 
Non-Profit
 
Pharmaceuticals
 
Public Relations
 
Technical Services
 
Travel
 
Other
 
 
 
Which category best describes your annual income?
 
Under $15,000
 
$15,000 - $29,999
 
$30,000 - $44,999
 
$45,000 - $59,999
 
$60,000 - $74,999
 
$75,000 - $89,999
 
$90,000 - $104,999
 
$105,000 - $119,999
 
$120,000 or more
 
Prefer not to answer
 
 
 
How many children do you have?
 
No Children
 
1 child
 
2 children
 
3 children
 
More than 3 children