Clinton Age Friendly Question Title * 1. What is your gender? Male Female Non-Binary Other (please specify) Question Title * 2. How old are you? 18-30 31-40 41-50 51-55 56-60 61-65 66-70 71-75 76-80 81-85 86-90 91-95 96-100 100+ Question Title * 3. Current employment situation. Please check (√) all that apply. Employed full time Volunteer work Employed part time Retired Other (please specify) Question Title * 4. We realize that income is a private matter so we will not ask for specific numbers. Please share your primary source of income. Check (√) all that apply. Employment Private investment and pension plans Canadian Government Payments (CPP, OAS, GIS, ASB) Other (please specify) Question Title * 5. Please check (√) your annual household income. Below $10,000 $10,000-$19,999 $20,000-$29,999 $30,000-$39,999 $40,000-$49,999 $50,000-$59,999 $60,000 and above Go to Next Page