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Your Demographics

This information is anonymous but is vitally important in making sure we are reaching ALL people in the region! Help us by providing the following info:

Organization(s)

If you are part of multiple organizations, please indicate each and separate them with commas.

County of Residence

Your Zip code:

What is your age?

What is your gender?

What is your race/ethnicity?

What is your marital status?

Have you or anyone in your household served on active duty in the U.S. Armed Forces, Reserves, or National Guard?

Do you or someone in your household have a physical or cognitive disability, either visible or not? (Please check any that apply)

Yes, I have a disability
Yes, someone in my household has a disability
No
Prefer not to answer

Do you or anyone in your household identify as LGBTQA+?

How would the area you live in be described?

What is the highest degree or level of school COMPLETED?

Which best describes the sector in which you are currently or were most recently employed?

Including yourself, how many people live in your household?

What is your total estimated household income?

Do you have access to the internet in your household?

What form of transportation do you normally use?

Personal vehicle
Motorcycle
Bicycle/Scooter
Taxi, Uber, Lyft, etc.
Walk
Public Transportation/Bus
Rely on relatives/friends
Prefer not to answer

Do you own or rent your residence?

Describe your current housing:

Your Neighborhood

What neighborhood to do you live in? Leave blank if you don't know.

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Your Demographics

Your Passions

Carry Forward/Leave Behind

Your Preferred Future

Optional Contact Info