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Name (Last Name Initial, Full First Name)
   
 
 
 
Year of Birth (19xx)
   
 
 
 
Gender?
 
Female
 
Male
 
 
 
Highest Level of Education
 
High School/GED
 
Some College
 
Associate's Degree
 
Bachelor's Degree
 
Master's Degree
 
Doctorate or PHD
 
Other
 
 
 
 
Political Affiliation
 
Republican
 
Democrat
 
Independent
 
I am not in to politics
 
Other
 
 
 
 
Race
 
Black or African American
 
White
 
Hispanic or Latino
 
Asian
 
Native American
 
Alaska Native, Hawaiian, or other Pacific Islands
 
Other
 
 
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