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  2. 2017
  3. May
  4. M
  5. Membership Demographic Survey
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Questions marked with a * are required Exit Survey
 
Contact Information
* First Name : 
* Last Name : 
* Address Line 1 : 
   Address Line 2 : 
* City : 
* State : 
* Zipcode : 
* Phone : 
* Email Address : 
 
 
 
* What is your date of birth?
MonthDayYear
  
 
 
 
* What is your marital status? 
 
Single
 
Married
 
Divorced
 
Widowed
 
Other
 
 
 
How many children do you have? 
   
What are their sexes and ages? (Please be specific)
   
 
 
 
What is your yearly income?  
 
$0-$30,000
 
$30,000-$50,000
 
$50,000-$80,000
 
$80,000-$100,000
 
$100,000 or more
 
 
 
* What is your highest education level? 
 
 
 
* What is your employment status? (Select all that apply)
 
Employed
 
Self-employed
 
Homemaker
 
Student
 
Retired
 
Unemployed and actively looking for work
 
Unemployed and NOT actively looking for work
 
Unable to work for health or other reasons

 
 
 
* Which of the following best describes your PRIMARY field of employment? 
 
 
 
What is your PRIMARY computing platform? 
 
Macintosh
 
Windows
 
Linux
 
Other/I don't know
 
 
 
* How many hours per week are you willing to volunteer your time and talents to Lambda Zeta Chapter? 
 
1-3 Hours
 
4-6 Hours
 
7-9 Hours
 
10 Hours or More