Skip to content
Pacific Cancer Foundation Support Group Initiative
Section 1: Demographics
1.
What is your role? (Select one)
Patient
Caregiver
Both
Other (please specify)
2.
What is your age group? (Select one)
Under 18
18-29
30-44
45-59
60-74
75+
3.
What is your ethnicity? (Select all that apply)
Native Hawaiian
Filipino
Japanese
Chinese
White/Caucasian
Hispanic/Latino
Black/African American
Other Pacific Islander
Other Asian
Other (please specify)
4.
What is your preferred language? (Select all that apply)
English
Hawaiian
Tagalog
Ilokano
Other (please specify)
5.
Where do you currently reside? (Select one)
Maui (Central)
Maui (West)
Maui (South)
Maui (Upcountry)
Maui (East)
Moloka‘i
Lana‘i
Other (please specify)