Surveys
2015
July
J
Jessica Smith Dissertation
Jessica Smith Dissertation
0%
Exit Survey
How old are you?
What is your gender?
Male
Female
Transgender
Other
What is your race? Please select all that apply.
Black/African American
American Indian or Alaska Native
White/Caucasian
Asian/Asian American
Native Hawaiian/Pacific Islander
Hispanic/Latino/Latina
Other
What is your current relationship status?
Single/divorced
Married/domestic partnership/living with a partner
Dating, not living together
Widowed/grieving the loss of a partner
Other
Where do you live?
City/urban area/downtown
Suburbs
Small town
Rural area/on a farm
Other
What part of the country do you live in?
Northeast, New England
South, Southeast
Southwest, West
Plains, Midwest
Non-continental U.S., U.S. territories
Other
Do you have health insurance? Select all that apply:
Yes, through my employer
Yes, through my partner's employer
Yes, through my parents
Yes, through an individual policy that I purchase
Yes, through Medicare
Yes, through Medicare plus a Medicare supplement
Yes, though Medicaid
No, I do not have health insurance
What is the highest level of education that you have completed?
Junior high
High school
Some college, 1 or 2 year degree or certificate
College degree (Bachelors)
Some graduate school
Graduate degree (ex: MA, MS, PhD, PsyD, MD, etc)
What was your total 2013 household income, before taxes?
What is your current weight in pounds?
Loading...
close
Loading...
Close
qpweb1.questionpro.net