What type of dwelling do you live in?
Apartment/Condominium Rent
Apartment/Condominium Own
Single Family Rent
Single Family Own
Townhouse Rent
Townhouse Own
Other Rent
Other Own
Do you have any children under the age of 18 living at home?
Yes
No
What is your date of birth?
Jan.
Feb.
March
April
May
June
July
Aug.
Sept.
Oct.
Nov.
Dec.
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Which best describes your race/ethnic background?
African America
Asian/Pacific Islander
Caucasian (not of Hispanic or Latino Origin)
Hispanic/Latino
Other
What is your marital status?
Married/Partnered
Single/Never Married
Divorced/Separated
Widow/Widower
What is the highest level of education you completed?
Less than High School
High School Degree
Some College
2 Year Degree
4 year Degree
Graduate/Professional School Degree
Are you currently employed?
Full-time
Part-time
Not Employed
Retired
What is your occupation?
(Select one only)
A-I
Account Executive (CPA)
Accountant
Accounting Asst.
Accounts Payable
Acount Manager
Actor/Dancer/Entertainer
Adherence Specialist
Administrative Assistant
Administrator
Admissions Officer
Advertising
Advisor
Advocate
Affiliate Support(Director)
Agriculture
Air Traffic Controller
Airline
Airport Screener
Analyst (Unspecified)
Animal Care/Pet Sitting
Appraiser
Architect
Archives Specialist
Art Therapist
Art/Artists
Art-Curator
Assembler
Assignment Technician
Assistant
Assistant Manager
Assistant Project Manager
Assistant Vice President
Assistant/Deputy Director
Assisted Living
Associate
Asst. Dir. Of Purchasing
Attorney
Audio Visual
Auditor
Babysitter
Banker
Banking (Bank Teller)
Banking(Mortgage)
Barber/Beautician/Hairdresser
Bartender
Benefits Analyst
Billing Analyst
Biologist
Biomedical
Bio-Metric
Biostatistician
Bookkeeper
Bookseller
Bouncer
Brick Layer
Budget Analyst
Building Engineer/Janitor
Building Manager/Super
Bureaucrat
Business Analyst
Business Developer
Business Manager
Business Owner
Buyer
Cab Driver
Cable Installer
Canvasser
Car Dealer
Car Porter
Care Giver
Caretaker
Carpenter
Cartographer
Case Analyst
Cashier
Caterer/Restaurant
CFO
Chef/Cook
Chemist
Child Care/Day Care
CIO
Civil Engineer
Claims Adjuster
Clergyman/Religious
Clerk
Client Relations
Coach
Collector
Commissioner
Communications
Communications (Director)
Community Service
Companion/Live in Aide
Compensation Analyst
Comptroller
Computer Programmer
Concerige
Conflict Resolution/Mediator
Congressional Assistant
Construction
Consultant
Consumer Services
Contract Administrator
Contracting Specialist
Contractor (Independent)
Controller
Coordinator
Copier Technician
Copy Writer
Corrections Officer
Cosmetologist
Costume Designer
Counselor
Courier/Delivery
CPA
CPO(Chief Purchasing Officer)
Craftsman
Credential Assistant
Credit (Mgr., Officer)
Crossing Guard
Customer Account Mgr.
Customer Representative
Data Analyst
Data Entry/Word Process
Dealer
Decorator
Defense
Demographer
Dental Technician
Design/Interior Design
Designer
Detailing
Detective/Investigator
Development
Dietician
Diplomat
Direct Mail
Direct Marketing
Disabled
Disc Jockey (DJ)
Dispatcher
Distributor
Document Analyst
Documentary Director
Dressmaker
Driver (Bus/Car)
Driver (Truck)
Ecologist
Economist
Editor
Editorial Assistant
Education (Asst Professor)
Education (Educational Administrator)
Education (Peer Educator)
Education (Principal)
Education (Reading Specialist)
Education (Special Education)
Education (Teacher/educator)
Education (Teacher/Elementary)
Education (Teacher/High)
Education (Teacher/Middle)
Education (Teachers Assistant)
Education (Vice Principal)
Education( Academic Specialist)
Education(Academic Advisor)
Education(Counselor)
Education(Dean-College)
Education(Health)
Education(Pre-School Teacher)
Educator (Professor)
Elections
Electrical Engineer
Electrician
Emergency Prep Specialist
Employment Specialist
Engineer
Enrollment Services
Entertainer
Environmental Spec/Consult
Equipment Operator
Estimator
Ethics Specialist
Evaluations/Estimator
Evangelist
Events Coordinator
Executive
Executive Assistant
Executive Recruiter
Exercise Physiologist
Exterminator
Facilities Mgr.
Fellow
Field Technician
File Manager
Film Preservation
Finance(Director)
Financial Administration
Financial Advisor
Financial Analyst
Financial Manager
Financial Planner
Fireman
Flight Attendent
Floor Director
Florist
Food (Miscellaneous)
Food Broker
Food Service Manager
Framer
Front Desk
Fundraiser
Funeral/Mortician
Gardener/Landscaper
General Mgr.
General Office
Genetic Counselor
Geologist
Gift Baskets
Glazer
Government - Misc.
Government Affairs
Graduate Assistant
Grants Specialist
Graphic Design
Groundskeeper
Guidance Counselor
Healthcare Specialist
Hearing Officer
Heating & Cooling Technician
Heavy Equipment Operator
Help Desk Specialist
Historian
Home Care Provider
Home Improvement
Homemaker
Homemaker/Housewife
Horseback Riding Instructor
Hospitality
Hostess
Housekeeper/Maid
Housewife
Housing Council
Housing Inspector
Human Resources
Import/Export
Indexer
Industrial Engineer
Industrial Hygienist
Information Specialist
Inspector (Public)
Install Coordinator
Instructor (Misc.)
Insurance (Adj./Examiners
Insurance (Agent/Underwriter)
Insurance (Billing)
Insurance(Broker)
Interior Designer
Intern
Interpreter/Translator/Linguist
Interviewer
Inventory Specialist
Investigator
Investment Banker
Investor - Property/Real Estate
Iron Worker
J-S
Janitor
Jeweler
Jewelry Designer
Journalist
Labor Relations
Laborer-Misc. (Unskilled)
Labortory Technician
Landscaping
Law (Gov't Affairs)
Law (Judicial Clerk )
Law (law professor)
Law (Legal Aide)
Law (Legal Secretary)
Law (Legislative Aide)
Law (Legislative Assistant)
Law (Legislative Director)
Law (Legislator)
Law (Paralegal)
Law (Parole Officer)
Law (Process Server )
Law Enforcement
Law Enforcement (Federal)
Law(Court Clerk)
Law(Criminal Justice)
Law(Probation Officier )
Leasing Representative
Legal Publishing
Legal(Court Reporter)
Legislative Assistant
Letter Carrier
Liaison
Librarian
Library Assistant
Lifeguard
Linguist
Liscensing Specialist
Lithographer
Loan Officer
Locksmith
Logistics
Loss Prevention
Machine Operator
Maid
Mailorder
Mailroom (Non-Federal Government)
Maintenance
Management Analyst
Management Executive
Manager
Manager (Product)
Manufacturer
Manuscript Coordinator
Market Planner
Marketing Consultant
Marketing Copy Writer
Marketing Director
Marketing Rep
Marketing/Advertising
Mason
Massage Therapist
Material Handler
Mathematician/Statistic
Meat Processor
Mechanical Engineer
Mechanics
Media (News Producer)
Media (Radio)
Media (Reporter)
Media (Television)
Media Advertising Planner
Media Contractor
Media Specialist
Medical (Assistant)
Medical (Bio-Medical)
Medical (Chiropractor/Asst)
Medical (Dental Asst./Hygienist)
Medical (Dentist)
Medical (Dietician/Nutritionist)
Medical (EMT)
Medical (Epidemiologist)
Medical (Health Specialist)
Medical (Internist)
Medical (Lab Technician)
Medical (LPN)
Medical (Manager)
Medical (Medical Billing)
Medical (Medical Receptionist)
Medical (Medical Records)
Medical (Medical Technologist)
Medical (Mental Health )
Medical (Mental Health Counselor)
Medical (Midwife)
Medical (Nuclear Medical Consultant)
Medical (Nurse Practitioner)
Medical (Nurse Register)
Medical (Nurse)
Medical (Nurses Asst)
Medical (Nursing Director)
Medical (Office Misc.)
Medical (Opticians)
Medical (Pediatrician)
Medical (Pharmacist)
Medical (Pharmacy Technician)
Medical (Physical Therapist)
Medical (Physician)
Medical (Psychiatrist )
Medical (Psychologists)
Medical (Psychotherapist)
Medical (Radiation Therapist)
Medical (Radiologist)
Medical (Registered Nurse)
Medical (Representative)
Medical (Research)
Medical (Respiratory Therapist)
Medical (Technician)
Medical (Technologist)
Medical (Transcriptionist)
Medical (Vetenarian)
Medical Director
Medical Receptionest
Medical(Optometrist)
Medical(Pharmacist-Assistant)
Medical(Physicians Assistant)
Medical(Sales)
Meeting Planner
Membership Coordinator
Merchandizer
Meter reader
Meterologist
Microbiologist
Military
Minister
Mortgage - Misc.
Mortgage Banking
Mortgage Broker
Motivational Speaker
Mover/Delivery
Museum Employee
Music Teacher
Musician
Nanny
News Broadcasting
Non-Profit
Nuclear Engineer
Nutritionist
Office Asst/Clerk
Office Automation Specialist
Office Cleaner
Office Supervisor/Manager
Officer
Operations Director
Organizer
Owner
Package Handler
Painter
Paralegal
Parole Officer
Partner
Party Planner
Pastor
Patent Examiner
Patient Account Specialist
Patient Rep.
Payment Posting
Payroll Manager
Personal Care
Personnel /Human Resource
Personnel Asst.
Photo Archivist
Photographer
Physical Fitness/Sports
Physical fitness/trainer
Physist
Pianist
Pilot (Plane/Helicopter)
Planner
Playground Monitor
Plummer
Police Officer
Policy Analyst
Political Activist
Political Co-ordinator
Porter
Postal
Pressman
Printer
Probation Officer
Procurement
Producer
Product Manager
Production Assistant
Prof (Banking (Banker))
Prof (Banking (Loan Officer))
Prof (Cad Operator)
Prof (CEO/President)
Prof (Computer (Network engineer))
Prof (Computer (programmer/analyst))
Prof (Computer (Software))
Prof (Computer (support/technician))
Prof (Computer (System Analyst))
Prof (Computer (Web Master/Editor)
Prof (Computer Scientist)
Prof (Computer Software Trainer)
Prof (Computer Specialist)
Prof (Computer-Misc.)
Prof (Consultant (Management))
Prof (Contractors/owners)
Prof (Controller/CFO)
Prof (Database Admin/Mgr)
Prof (Database Mgr)
Prof (Director/Executive Director)
Prof (Economist)
Prof (Information Technology)
Prof (Internet Specialist)
Prof (Intl Affairs (Director))
Prof (Law (Judge))
Prof (Law (Lawyer))
Prof (Lobbyist)
Prof (Owners)
Prof (Stock Broker)
Prof (Vice President)
Prof (Web Designer)
Professional (Computer Specialist)
Professional (Digital Media Design)
Professional (Software Manager)
Professional Athlete
Professional Misc.
Professional(Chief Information Officer)
Professional(Chief of Staff - COS)
Professional(COO/Chief Operating Officier)
Professional(Desktop Publisher)
Professional(Information Technology)
Program Analyst
Program Assistant
Program Coordinator
Program Manager
Program Specialist
Project Manager
Promoter
Proofreader
Property Analyst
Property Manager
Pubic Health Advisor
Public Administration
Public Affairs/Relations (Director)
Public Relations
Public Safety
Public Speaking
Public Works
Publicist
Publisher
Purchasing/Acquisition
Quality Contol
Quilter
Rabbi
Railroad
Reader
Real Estate Agent
Real Estate Broker
Realtor
Receptionist
Records Manager
Recreation
Recruit
Refused
Registrar
Rehab Specialist
Reimbursment Specialist
Repairman (Mech/Electr)
Reporter
Representative
Research Analyst
Research Assistant
Reservations Agent
Resolution Specialist
Resource Manager
Retail Manager
Retail Salesperson
Retail Store Owner
Retired
Retirement Specialist
Risk Mgr.
Safety Director
Sailors
Sales & Marketing
Sales Manager
Sales Representative
Salesperson
Scheduling Coordinator
Scientist
Seamstress/Tailor
Secretary
Security (Expert)
Security (Guards/Watchman)
Security (Officer/Guard)
Self Employed (Home)
Self Employed (Unspec)
Server
Service Officer
Services (Misc.)
Settlement Coordinator
Sheet Metal
Sheriff
Shipping/Receiving Clerks
Sign Language
Singer
Site Administrator
Small Business Owner
Social Scientist
Social Worker
Songwriter
Speaker(Public/Motivational)
Speech Therapist
Speech Writer
Sports Coach
Staff Assistant
Staffing Technician
State Government-Misc.
Statistician
Stenographers
Stock Broker
Stocker
Store Owner
Student
Supervisor
Supply Specialist
Support Specialist
Surgical Technician
Surveyors
System Administrator
Systems Engineer
T-Z
Tax Preparer
Team Leader
Technical Advisor
Technical Assistant
Technical Writer
Technician (General)
Telecommunications Manager
Telemarketing
Telephone Operators
Telephone Servicemen
Temporary
Theraputic Specialist
Tour Guide
Tow Operator
Toxicologist
Trade Association
Trade Specialist
Train Operator
Trainer
Training specialist
Transcriptionist
Translator
Transportation - Operator
Transportation Specialist
Travel Agent
Truancy Director
Tutor
TV Production
Typist
Unemployed
Union Official
Unknown
Upholster
Urban Planner
Usher
Utility Worker
Valet Parking
Venture Capitalist
Veterinarian
Video Editor
Volunteer
Waiter/Busboy/Hostess
Warehouse Manager
Warehouse Worker
Welder
Wellness
Witness Selection Specialist
Word Processor
Writer/Author
Writer-Freelance
Yoga Instructor
Youth Director
If not listed, please specify:
In what industry do you work?
What party do you affiliate yourself with?
Democrat
Republican
Independent
Unknown/Refused
What is your annual household income?
Under $10,000
$10,000-$19,999
$20,000-$29,999
$30,000-$39,999
$40,000-$49,999
$50,000-$59,999
$60,000-$69,999
$70,000-$79,999
$80,000-$89,999
$90,000-$99,999
$100,000-$119,999
Over $120,000