$100 Online Opinion Study Question Title * 1. Contact Info Name Phone E-Mail Gender Age State Question Title * 2. What is your annual household income (before tax)? 1. My household does not have an income 2. Under $15,000 3. $15,000 to $24,999 4. $25,000 to $34,999 5. $35,000 to $49,999 6. $50,000 to $74,999 7. $75,000 to $99,999 8. $100,000 to $149,999 9. $150,000 to $199,999 10. $200,000 and over Question Title * 3. Are you of Hispanic, Latino, or Spanish origin? 1. No 2. Yes – Mexican, Mexican American, Chicano 3. Yes – Puerto Rican 4. Yes – Cuban 5. Yes – Brazilian 6. Yes – other Hispanic, Latino, or Spanish origin Question Title * 4. Which of these best describes your racial background? Please select all that apply. 1. White 2. Black or African American 3. American Indian or Alaskan Native 4. East Asian 5. South Asian 6. Native Hawaiian or other Pacific Islander 7. Middle Eastern Other (please specify) Question Title * 5. Which of the following languages do you speak fluently and/or at home?Please select all that apply. Spanish Chinese (Mandarin) Arabic English French Portuguese German Russian Korean Japanese Italian Other (please specify) Question Title * 6. What is the highest level of education you have completed? Less than a high school diploma High school degree or equivalent (e.g., GED) Some college, no degree Associate’s degree Trade certification or technical degree Bachelor's degree Master’s degree Professional degree Doctoral degree Question Title * 7. What is your current employment status? Working full time (40 or more hours per week) Working part time (less than 40 hours per week) Full time student Retired Unemployed Other (not working) Next
