Personal Income Survey Form
Please complete this form to help us understand income trends. Your responses are confidential and will be used for research purposes only.
Full Name
*
First Name
Last Name
Age
*
Gender
*
Male
Female
Non-binary
Prefer not to say
Highest Level of Education Completed
*
Please Select
Less than high school
High school diploma or equivalent
Associate degree
Bachelor’s degree
Master’s degree
Doctorate or professional degree
Other
Current Employment Status
*
Employed full-time
Employed part-time
Self-employed
Unemployed
Retired
Student
Annual Personal Income (before taxes)
*
Please Select
Less than $25,000
$25,000 - $49,999
$50,000 - $74,999
$75,000 - $99,999
$100,000 - $149,999
$150,000 or more
Prefer not to say
What are your primary sources of income?
*
Salary/Wages
Business/Entrepreneurship
Investments
Pensions
Government assistance
Other
How satisfied are you with your current income?
*
1
2
3
4
5
How would you describe your ability to meet your financial needs?
*
Very Difficult
1
2
3
4
Very Easy
5
1 is Very Difficult, 5 is Very Easy
If you wish, please share any comments about your income situation.
Submit Survey
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