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Demographics Survey
Please make a note that this information is confidential and not attached to your name.
Ethnicity (Please only choose one)
Hispanic or Latino
Not Hispanic or Latino
Unknown
Race (you can select more than one)
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Refuse to answer
Unknown
Other (please list)
Other Race
What sex were you assigned at birth on your original birth certificate?
Male
Female
X
What is your current gender?
Woman
Man
Non-Binary
Transgender woman
Transgender man
Decline to answer
Other (if other gender, please specify):
Other Gender
Which of the following best represents how you think of yourself?
Bisexual
Choose not to disclose
Do not know
Heterosexual (not lesbian, gay, or bisexual)
Lesbian or Gay
Other (if other sexual orientation, please specify):
Other sexual orientation
Zip Code (please write the zip code of the city where you currently live)
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