Surveys 2015 April D Draft1

Draft1

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Exit Survey

What range does your age fall within?   23-29   30-39   40-49   50-59   60-69   70-79   80-89   90-99       What is your level of education?   High School   Some College   Trade/Vocational/Technical   Associates   Bachelors   Masters   Professional   Doctorate       What is your gender?   Male   Female       What is your race/ethnicity?   Hispanic or Latino   American Indian or Alaska Native   Asian   African American   Native Hawaiian or Other Pacific Islander   White   Other       Do you consider yourself a religious individual?   Strongly disagree   Somewhat disagree   Neither agree nor disagree   Somewhat agree   Strongly agree       Do you consider yourself a spiritual individual?   Strongly disagree   Somewhat disagree   Neither agree nor disagree   Somewhat agree   Strongly agree       Which religion do you belong to?   Christianity   Islam   Judaism   Hinduism   Buddhism   Sikh   Shinto   Jainism   Agnostic   Atheist   Other       How many years of experience do you have diagnosing mental illness?   0-1   2-5   6-10   11-15   16-20   21-30   31-40   41-50