Shelby County 2019 Community Health Needs Assessment Survey

This set of questions is for analysis purposes only. This information will not be used to identify you as a participant. The information is important to ensure that we have responses from all members of your community.

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* 1. In what year were you born?

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* 2. Do you consider yourself...Please check all that apply.

White or Caucasian

Black or African American

Asian

Native American or Pacific Islander

Other (please specify)

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* 3. Do you consider yourself Hispanic or Latino/a?

Yes

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* 4. What is your zip code?

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* 5. What is your gender?

Male

Female

Prefer not to say

Other (please specify)