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fishyfishy

Int Survey

fishyfishy
Jun 21st, 2016
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  1. Age Range?
  2. #1-18 #18-30 #30-50 #50+
  3.  
  4. Citizenship?
  5. $Yes $No
  6.  
  7. Income Bracket
  8.  
  9. Gender Identity?
  10. +Male +Female +Transgender +N/A
  11.  
  12. LGBTQ status?
  13. +Heterosexual +Homosexual +Bisexual +Pansexual +Asexual
  14. ` As one of the most at risk
  15.  
  16. Marriage Status?
  17. +Married +Single +Widowed +Other
  18.  
  19. Parenting Status?
  20. +Yes +No (+Adoptive parent) (+Legal Guardian)
  21.  
  22. Physical Disability?
  23. $Yes $No
  24.  
  25. Mental Illness?
  26. $Yes $No
  27.  
  28. Military?
  29. $Yes $No
  30.  
  31. Race and Ethnicity?
  32. +Black +White +Asian +Other
  33.  
  34. LatinX?
  35. $Yes $No
  36.  
  37.  
  38.  
  39.  
  40.  
  41.  
  42. Receiving Government Aid?
  43. $Yes $No
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