Demographic Survey

Date of submission

Month

Day

Year

(Please check all that apply.)

How did you hear about us? *

How did you hear about us? Other. Please describe:

To which gender do you identify with most?

Gender *

Female

Male

Non-binary/Third gender

Prefer to self describe:

Gender Prefer to self describe:

Do you identify as transgender? *

Yes

No

Do you identify as Black, Indigenous and/or a person of color? *

Yes

No

Please check all that apply.

Race / Ethnicity (Please check all that apply.) *

Native American, American Indian or Alaska Native

Asian or Asian American

Black or African American

Latina/Latino/Latinx

Native Hawaiian or other Pacific Islander

Middle Eastern

Slavic

White/European

Prefer to self describe:

Race / Ethnicity (Please check all that apply.) Prefer to self describe:

Which category/categories do you identify with (please check all that apply)? *

I have or am living with a disability

I have or am living with an impairment

I have accessibility needs

I have or am living with a chronic illness/health condition that may affect my participation

Not applicable

Prefer to self describe:

Which category/categories do you identify with (please check all that apply)? Prefer to self describe:

Do you speak a language other than English at home? If yes, which language(s):

Select your age from the list below: *

The list below indicates 80% of the 2021 average household income in the Portland-Vancouver-Hillsboro Metro Area. Please find your household size and indicate whether your household is below (or at) that number or above. *

I subscribe to: *

Cable TV

Internet service

Internet and cable TV

None of the above