HeySurvey survey

Community & Background Information Survey

What is your age?*

Please select the age group that best describes you.

Under 18
18-24
25-34
35-44
45-54
55-64
65 or older

What is your sex?*

Choose the option that best fits how you are recorded for this survey.

Male
Female
Prefer to self-describe
Prefer not to answer

Are you of Hispanic, Latino, or Spanish origin?*

This helps us better understand the backgrounds of people taking part.

No
Yes, Mexican, Mexican American, or Chicano
Yes, Puerto Rican
Yes, Cuban
Yes, another Hispanic, Latino, or Spanish origin
Prefer not to answer

What is your race?*

Select all that apply.

White
Black or African American
American Indian or Alaska Native
Asian
Native Hawaiian or Other Pacific Islander
Some other race
Prefer not to answer

What is the highest level of education you have completed?*

Please choose the highest grade or degree you have finished.

Less than high school
High school diploma or GED
Some college, no degree
Associate degree
Bachelor's degree
Graduate or professional degree

What is your current employment status?*

Pick the option that best describes your current work situation.

Employed full-time
Employed part-time
Self-employed
Unemployed and looking for work
Unemployed and not looking for work
Student
Retired
Unable to work

What is your annual household income before taxes?

Your best estimate is fine. This information helps group responses by income range.

Less than $25,000
$25,000-$49,999
$50,000-$74,999
$75,000-$99,999
$100,000-$149,999
$150,000 or more
Prefer not to answer

What is your housing situation?*

Tell us which option best matches where you live now.

Own with a mortgage or loan
Own free and clear
Rent
Live with family or friends without paying rent
Temporary housing
Other

How many people live in your household, including you?*

Count everyone who lives there most of the time.

Thank you for taking a part in this survey.

This is a HeySurvey survey template.