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Surveys
2016
March
C
Childhood Depression
Childhood Depression
0%
Questions marked with a
*
are required
Exit Survey
*
What is your age?
18-29 years old
30-49 years old
50-64 years old
65 years and over
What is your gender?
Male
Female
What is the highest level of education you have completed?
some high school
high school graduate
some college
trade/technical/vocational training
college graduate
some postgraduate work
post graduate degree
What is your religious preferences?
Christian Scientist
Jewish
Mormon
Roman Catholic
an Orthodox church such as the Greek or Russian Orthodox Church
Seventh-Day Adventist
Muslim
Protestant
Something else (please specify)
Other
*
Race: What is your race? Are you white, African-American, or some other race?
white
African-American
Other
Ethnicity: We want to be sure that we have spoken to a broad mix of people in your area. Are you, yourself, of Hispanic origin or descent, such as Mexican, Puerto Rican, Cuban, or other Spanish background?
Yes
No
Is your total annual income before taxes $20,000 or more, or is it less than $20,000?
Under $20,000
Over $20,000
What is your marital status?
single/never been married
married
separated
divorced
widowed
How many children live in your household who are...
Less than 5 years old?
5 through 12 years old?
13 through 17 years old?
Which of the following most closely matches your job title?
Intern
Entry Level
Analyst / Associate
Manager
Senior Manager
Director
Vice President
Senior Vice President
C level executive (CIO, CTO, COO, CMO, Etc)
President or CEO
Owner
Other
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