Demographic Profile Report Form
Please complete the Demographic Profile Report Form to help us understand your background. All questions are required for reporting purposes.
Full Name
*
First Name
Last Name
Age
*
Gender
*
Male
Female
Non-binary
Prefer not to say
Other
Ethnicity
*
Please Select
White
Black or African American
Hispanic or Latino
Asian
Native American or Alaska Native
Native Hawaiian or Other Pacific Islander
Two or More Races
Other
Marital Status
*
Single
Married
Divorced
Widowed
Other
Highest Education Level Completed
*
Please Select
Less than high school
High school diploma or equivalent
Some college, no degree
Associate degree
Bachelor’s degree
Master’s degree
Doctorate or professional degree
Other
Employment Status
*
Employed full-time
Employed part-time
Self-employed
Unemployed
Student
Retired
Other
Occupation / Industry
*
Household Income Range (per year)
*
Please Select
Under $25,000
$25,000 - $49,999
$50,000 - $74,999
$75,000 - $99,999
$100,000 - $149,999
$150,000 - $199,999
$200,000 or more
Prefer not to say
Location (City, State/Province, Country)
*
Submit
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