Neighborhood Demographics Gender: How do you identify? Male Female Non-binary or gender fluid I prefer not to disclose. Other (please specify):Other (please specify): Race/Ethnicity: How do you identify? Asian Black or African American Hispanic or Latino Middle Eastern or North African Multiracial or Multiethnic Native American or Alaska Native White Native Hawaiian or other Pacific Islander Prefer not to disclose Other (please specify):Other (please specify): Age: Which generation best describes you currently? 1928-1945 (Silent) 1946-1965 (Baby Boomer) 1966-1976 (Generation X) 1977-1994 (Generation Y-Millennial) 1995-2012 (Generation Z) Age What is the primary language spoken at home? English Spanish French Other Military Status I am currently serving in the United States military I am a United States veteran I am not a veteran Spouse of active military I choose not to identify Disability Status I have a seen or unseen disability I do not have a disability I choose not to identify What is the highest level of school that you have completed? Primary school Some high school, but no diploma High school diploma (or GED) Some college, but no degree 2-year college degree (Associates) 4-year college degree (Bachelor's) Graduate-level degree (Master's) Professional Degree (MD, DDS, DVM) Doctorate (PhD, EdD) I choose not to identify Religious Affiliation Christian Catholic Jewish Muslim Buddhist Hindu Unaffiliated (Atheist/Agnostic) Other (please specify):Other (please specify): Choose not to identify Political Affiliation Independent Republican Democrat Libertarian Green Other Choose not to identify What is your total household income? Less than $19,999 $20,000 to $39,999 $40,000 to $59,999 $60,000 to $79,999 $80,000 to $99,999 $100,000 to $119,999 $120,000 to $139,999 $140,000 to $159,999 $160,000 to $179,999 $180,000 to $199,999 $200,000 or More Prefer not to say What is your insurance status? Uninsured Insured -- Medicaid Insured -- Medicare Insured -- Private Insurance Prefer not to disclose What is your marital status? Single Unmarried; living with partner Married Separated Divorced Widowed Choose not to identify What language(s) do you mainly speak at home? English Spanish Chinese Russian Vietnamese French Some other languageSome other language If you are human, leave this field blank. Submit
