Lincoln County Substance Use Community Survey

1. Demographics

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* 1. What is your 5 digit zip code

54452

54435

54442

54564

54532

54487

Other (please specify)

Question Title

* 2. Which of the following best represents your current occupation?

Healthcare / Treatment Provider

Education / Teacher / Professor

Small Business Owner

Student / Youth

Law / Criminal Justice

Broadcasting / Media / Social Media

Social Services / State / Local / Tribal Govt.

Religious Organization

Youth Serving Agency / Childcare

Skilled Labor / Agriculture

Service Industry / Retail / Food Service

Retired

Unemployed

Other (please specify)

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* 3. What is your highest level of education?

Some high school

High school diploma, GED, or other equivalent

certificate

Some College

Associate's degree

Bachelor's degree

Master's degree

Doctorate degree

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* 4. What is your estimated household income including all sources before taxes?

Less than $10,000

$10,000 to $19,999

$20,000 to $29,999

$30,000 to $39,999

$40,000 to $49,999

$50,000 to $59,999

$60,000 to $69,999

$70,000 to $79,999

$80,000 to $89,999

$90,000 to $99,999

$100,000 to $149,999

$150,000 or more

Prefer not to answer

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* 5. Including yourself, how many people currently live in your household?

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* 6. Do you currently have health insurance?

Yes

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* 7. Which category best describes you? Select all that apply.

American Indian or Alaska Native

Asian

Black or African American

Hispanic, Latino, or Spanish

Middle Eastern or North African

Native Hawaiian or Other Pacific Islander

White

Other

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* 8. Which sex was assigned to you at birth?

Female

Male

Other

Prefer not to answer

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* 9. Are you currently enrolled in Medicare/Badgercare?

Yes

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* 10. What is your sexual orientation?

Heterosexual (straight)

Homosexual (lesbian/gay)

Bisexual

Transgender

Unsure

Other

prefer not to answer

Question Title

* 11. How old are you?

Under 18

18-24

25-34

35-44

45-54

55-64

65+