$225 Opinion Study Question Title * 1. Contact Info Name Phone E-mail State Gender Age Year Born: Question Title * 2. Are you of Hispanic, Latino or Spanish origin? Select one No, not of Hispanic, Latino or Spanish origin Yes, of Hispanic, Latino or Spanish origin Prefer not to answer Question Title * 3. What is your race or ethnic heritage? If appropriate you may select more than one answer if this best describes you. Select all that apply. Black American Indian or Alaska Native South Asian (India, Pakistan, Bangladesh, etc.) Southeast or East Asian (China, Japan, Korea, Philippines, Vietnam, etc.) White/Caucasian Prefer to self-identify (please specify ___________) Question Title * 4. Which of the following best describes your employment status? Employed full-time (40 hrs./wk. or more) Employed part-time (30-40 hrs./wk.) Employed part-time (less than 30 hrs./wk.) Self-employed full-time or part-time Student Homemaker Retired Unemployed Other (please specify) Question Title * 5. What is your current or previous..... Occupation/Title Industry Company You Work/Worked For Next
