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What is your age?
Under 18
18 - 24
25 - 34
35 - 44
45 - 54
55 - 64
65 - 74
75 - 84
85 or older
What is your zipcode?
What is your gender?
Male
Female
Other
What is your highest level of education?
Less than high school
High school graduate
Some college
2 year degree
4 year degree
Professional degree
Doctorate
What is your ethnicity?
White
Black or African American
American Indian or Alaska Native
Asian
Native Hawaiian or Pacific Islander
Latino/Hispanic
Email
Phone
Preferred contact for survey
Text
Phone call
Email
Approximately how often would you like to take surveys?
Once a month
Several times a month
A few times a year
Once a year
How did you hear about our survey project?
Print media
Social media
Friend/family
Flyer
University member
Other
First name
Last Name
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