Community Health Survey Demographics Form
Age
Gender
Male
Female
Non-binary
Other
Prefer not to say
Ethnicity
White
Black or African American
Asian
American Indian or Alaska Native
Native Hawaiian or Pacific Islander
Hispanic or Latino
Other
Prefer not to say
Highest Level of Education Completed
Less than high school
High school diploma or equivalent
Some college
Associate degree
Bachelor's degree
Graduate or professional degree
Prefer not to say
ZIP / Postal Code
Number of People in Household