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Age
   
 
 
 
Gender
 
Male
 
Female
 
Transgender/Transsexual
 
 
 
Race
 
Unknown
 
White
 
Black
 
Asian
 
Hispanic
 
Native American
 
Pacific Islander
 
Other
 
 
 
Marital Status
 
Unknown
 
Single
 
Married
 
Separated
 
Widowed
 
Divorced
 
Unmarried Partners
 
 
 
Family Type
 
Two Biological/Adoptive/Homosexual Partners
 
Single Parent
 
Cohabiting Parents
 
 
 
How many children do you have?
   
 
 
 
If you have more than one child, are they all from the same partner?
 
Yes
 
No
 
 
 
How old were you when you had your first child?
   
 
 
 
What is the highest grade you completed in school?
   
 
 
 
What is your employment status?
 
Unknown
 
Unemployed
 
Employed Full Time
 
Employed Part Time
 
Not Employed because of Disability
 
Retired
 
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