Identification, Please
Page One
1.
Age
-- Please Select --
Under 18
18–25
25–35
35–45
45–60
60+
Prefer not to answer
2.
Gender
-- Please Select --
Female
Male
3.
Nationality
4.
Race
-- Please Select --
American Indian/Alaskan native
Asian/Pacific Islander
Black
Hispanic
Middle Eastern
Non-Hispanic white
5.
Marital status
-- Please Select --
Single
Married
Divorced
Widowed
6.
Income
-- Please Select --
Under 15k
15k–40k
40k–60k
60k–100k
Over 100k
Prefer not to answer
7.
Religion
-- Please Select --
Agnostic
Atheist
Buddhist
Christian
Hindu
Jehovah’s Witness
Jewish
Mormon
Muslim
Pagan
Prefer not to answer
8.
Profession
-- Please Select --
Accounting/Finance/Banking
Admininstration/Clerical/Reception
Advertisement/PR
Architecture/ Design
Arts/Leisure/Entertainment
Beauty/Fashion
Buying/Purchasing
Construction
Consulting
Customer Service
Distribution
Education
Health Care (Physical & Mental)
Human resources management
Management (Senior/Corporate)
News/Information
Operations/Logistics
Planning (Meeting, Events, etc.)
Production
Real Estate
Research
Restaurant/Food service
Sales/Marketing
Science/Technology/Programming
Social service
Student
Other
N/A-Unemployed/Retired/Homemaker
9.
Which of the above questions were difficult to answer because you didn’t fit neatly in one of the categories? Why?
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