$100 Opinion Study Question Title * 1. Contact Info Name Phone E-Mail Question Title * 2. Are you... Male Female Prefer to self-identify: Question Title * 3. Please state your age Question Title * 4. In which state is your primary residence? Question Title * 5. 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 – other Hispanic, Latino, or Spanish origin Question Title * 6. 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. Asian 5. Native Hawaiian or other Pacific Islander Other (please specify) Question Title * 7. What is your current employment status? 1. Working full time (30 or more hours per week) 2. Working part time (Less than 30 hours per week) 3. Full time student 4. Retired 5. Unemployed 6. Other not working Question Title * 8. What is your current or previous...... Occupation Industry Employer Next
