Service Provider Demographic Survey Form
Please complete the Service Provider Demographic Survey Form to help us understand the backgrounds and contexts of service providers. Your responses support our efforts to improve services and inclusivity.
What is your current professional role?
*
What type of organization do you work for?
*
Please Select
Nonprofit
Government Agency
Private Company
Educational Institution
Healthcare Organization
Other
How many years have you worked in your field?
*
Please Select
Less than 1 year
1-3 years
4-7 years
8-15 years
More than 15 years
What is your primary service area?
*
Which population(s) do you primarily serve?
*
Children/Youth
Adults
Older Adults
Families
Individuals with disabilities
Other
What is the approximate size of your organization?
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1-10 employees
11-50 employees
51-200 employees
201-500 employees
More than 500 employees
What is your age range?
Under 25
25-34
35-44
45-54
55-64
65 or older
Prefer not to say
What is your gender identity?
Woman
Man
Non-binary
Prefer not to say
Prefer to self-describe
Which race or ethnicity do you identify with? (Select all that apply)
Asian
Black or African American
Hispanic or Latino/a/x
Indigenous/Native
Middle Eastern or North African
White
Prefer not to say
Prefer to self-describe
Which languages do you use to provide services? (Select all that apply)
English
Spanish
Mandarin
French
Other
Submit
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