U.S. Demographics Template
1.
In what state or U.S. territory do you live?
Alabama
Alaska
American Samoa
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia (DC)
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Marianas Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Virgin Islands
Washington
West Virginia
Wisconsin
Wyoming
2.
Are your living quarters owned or being bought by you or someone in your household, rented for cash, or occupied without payment of cash rent?
Owned or being bought by you or someone in your household
Rented for cash
Occupied without payment of cash rent
3.
What is your gender identity?
Man
Woman
Non-binary
Prefer to self-describe (please specify)
4.
Which category below includes your age?
17 or younger
18-20
21-29
30-39
40-49
50-59
60 or older
5.
Are you now married, widowed, divorced, separated, or never married?
Married
Widowed
Divorced
Separated
Never married
6.
What is the highest level of school you have completed or the highest degree you have received?
Less than high school degree
High school degree or equivalent (e.g., GED)
Some college but no degree
Associate degree
Bachelor degree
Graduate degree
7.
Which race or ethnicity best describes you? (Select all that apply)
American Indian or Alaska Native
Asian or Asian-American
Black or African-American
Hispanic or Latino/a
Middle Eastern or North African
Native Hawaiian or Pacific Islander
White
Another race (please specify)
8.
Does anyone in your household own a business or a farm?
Yes
No
9.
Which of the following categories best describes your employment status?
Employed, working 1-39 hours per week
Employed, working 40 or more hours per week
Not employed, looking for work
Not employed, NOT looking for work
Retired
Disabled, not able to work
10.
How much total combined money did all members of your HOUSEHOLD earn in 2010? This includes money from jobs; net income from business, farm, or rent; pensions; dividends; interest; social security payments; and any other money income received by members of your HOUSEHOLD that are EIGHTEEN (18) years of age or older. Please report the total amount of money earned - do not subtract the amount you paid in taxes or any deductions listed on your tax return.
$0 - $4,999
$5,000 - $7,499
$7,500 - $9,999
$10,000 - $12,499
$12,500 - $14,999
$15,000 - $19,999
$20,000 - $24,999
$25,000 - $29,999
$30,000 - $34,999
$35,000 - $39,999
$40,000 - $49,999
$50,000 - $59,999
$60,000 - $74,999
$75,000 - $99,999
$100,000 - $149,999
$150,000 or More
11.
How much money did YOU personally earn in 2010? This includes money from jobs; net income from business, farm, or rent; pensions; dividends; interest; social security payments; and any other money income received by YOU. Please report the total amount of money you earned - do not subtract the amount you paid in taxes or any deductions listed on your tax return.
$0 - $9,999
$10,000 - $19,999
$20,000 - 29,999
$30,000 - $39,999
$40,000 - $49,999
$50,000 - $59,999
$60,000 - $69,999
$70,000 - $79,999
$80,000 - $89,999
$90,000 - $99,999
$100,000 or More
Current Progress,
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