Longitudinal Study Respondent Demographics Form
Personal Information
Full Name
Date of Birth
Gender
Male
Female
Other
Prefer not to say
Ethnicity
Email Address
Phone Number
Current Address
Socioeconomic Information
Highest Level of Education Completed
Less than high school
High school graduate
Some college
Associate degree
Bachelor’s degree
Graduate degree
Current Employment Status
Employed full-time
Employed part-time
Self-employed
Unemployed
Student
Retired
Other
Household Size
Estimated Annual Household Income
Health Information
Do you have any physical or mental disabilities?
Yes
No
Prefer not to say
Do you have any chronic health conditions?
Yes
No
Prefer not to say
Additional Notes