Name
*
First Name
Last Name
Ethnicity origin (or Race): Please specify your ethnicity.
*
African-American or Black
Hispanic or Latino
White
Native American or American Indian
Asian/Pacific Islander
Other
Gender
*
Male
Female
Non-Binary
Date of Birth
*
MM
DD
YYYY
Email
*
Social Media Accounts
X (please format your handle properly and include the @)
Instagram (please format your handle properly and include the @)
Education: What is the highest degree or level of school you have completed?
No schooling completed
High School or equivalent (GED)
Trade/Technical/Vocational
Associate Degree
Bachelor's Degree
Master's Degree
Professional Degree
Doctorate Degree
Employment Status: Are you currently...?
Employed (Full Time)
Employed (Part Time)
Homemaker
Student
Retired
Unemployed/In between jobs
Household Income: What is your total household income?
Less than $10,000
$10,000-$39,999
$40,000-$69,999
$70,000-$99,999
$100,000-$149,999
$150,000 +
Marital Status: What is your marital status?
*
Single/Never Married
Married or Domestic Partnership
Widowed
Divorced
Separated
Children: How many children do you have?
0
1
2
3
4
5+
