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Help us envision the Proposed Burlington History & Culture Center.

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* 1. Where was your best museum / historical site experience?

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* 2. Tell us what part of Burlington's history most interests you. Please include any ideas you have in the following areas:

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* 3. What museum features would be important to you in a Burlington History & Culture Center (like a kitchen, performance / educational spaces, sculptures)?

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* 4. Demographic Questions (optional)

Please tell us what AGE RANGEyou fall in:

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* 5. What is the gender that you identify with:

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* 6. If you feel comfortable doing so please relate your sexual orientation:

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* 7. If you live in Burlington, please indicate which WARD your home is located within:

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* 8. Please describe your racial and ethnic identity (please check all that apply):

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* 9. If you selected American Indian or Native Alaskan, please provide some additional information (check all that apply):

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* 10. If you selected Asian, please provide additional information (check all that apply):

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* 11. If you selected Black (from the Americas), please provide additional information (check all that apply):

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* 12. If you selected Black (from outside the Americas), please provide additional information (check all that apply):

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* 13. If you selected Hispanic or Latino/a, please provide additional information (check all that apply):

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* 14. If you selected Middle Eastern, please provide some additional information (check all that apply):

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* 15. If you selected Native Hawaiian or Pacific Islander, please provide additional information (check all that apply):

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* 16. If you selected White, please provide additional information (check all that apply):

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