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What is your age?
 
18-24
 
25-34
 
35-44
 
45-54
 
54 or older
 
 
 
What is your gender?
 
Male
 
Female
 
 
 
What is the highest level of education you have completed?
 
Grammer school
 
10th grade
 
11th grade
 
High school graduate
 
GED
 
Some college
 
Associates Degree
 
Bachelors Degree
 
Master's Degree
 
 
 
What is your race?
 
Arab
 
Asian/pacific Islander
 
Black
 
Caucasian
 
Hispanic
 
Indigenous or Aboriginal
 
Latino
 
Multiracial
 
Other
 
 
 
 
What is the current household income in U.S. dollars?
 
Under $10,000
 
10,000-24,000
 
25,000-39,000
 
40,000-54,000
 
55,000-74,000
 
75,000-99,000
 
100,000-150,000
 
Would rather not say
 
 
 
Which best describes your primary area of employment?
 
Homemaker
 
Student
 
Employed
 
Unemployed
 
Retired
 
 
 
Where there any significant traumatic events in your family while you were growing up? For example, did any of the following events occur in your family: death of a parent or sibling, hospitalization of a parent or sibling, incarceration of a parent or sibling, divorce or chronic disease?
 
Yes
 
No
 
 
 
How often do you conduct surveys?
 
Weekly
 
Monthly
 
Quarterly
 
Annually
 
 
 
Where you treated harshly as a child?
 
Yes
 
No
 
 
 
Did you ever experience physical, sexual or emotional abuse?
 
Yes
 
No
 
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