Please answer the following information about yourself.
Gender
Male
Female
Date of birth
Marital Status
Single
Married
Divorced
Widowed
Household Situation
Living With Friends
Living With Family
Living With Roommate
Living Alone
Living With Significant Other
Race & Ethnicity (Check all that may apply)
Caucasian
African-American
Asian
Hispanic/Latino
Native American
East Indian
Middle Eastern/Persian
Other
Religious Background (If none, please enter "none".)
Is this your current religion?
Yes
No
Place of Birth
Number of years you have lived in the U.S.
years
Enter your native language
Do you speak any other languages?
Yes
No
If yes, please specify.
How would you characterize the economic level of the household in which you grew up?
Low Income
Low-Middle Income
Middle Income
High-Middle Income
High Income
Occupation
Select the number of hours you work per week for income
1-5 hours per week
5-10 hours
10-20 hours
20-40 hours
40+ hours
Select your annual income range.
less than $10,000
$10,000-$20,000
$20,000-$30,000
$30,000-$50,000
$50,000-$75,000
$75,000-$100,000
over $100,000
List your other sources of support (i.e. family, financial aid, trusts, etc.) (If none, please enter "none".)
Education Level
Are you currently a student?
Yes
No
List degrees attained (If none, please enter "none".)
Last 6 Digits of Social Security Number (to obtain credit for your participation; else enter "not applicable")