LMC Enrollment

The following questions will be used for general analytical use only and your responses will not be connected to your identity in any way in this analysis. All questions are voluntary.

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* 1. What is your name (first and last)?

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* 2. What is your email address?

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* 3. What is your phone number?

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* 4. What is your address?

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* 5. Which category best describes you? Please select all that apply.

American Indian or Alaska Native

Asian

Black or African American

Hispanic or Latino/a

Middle Eastern or North African

Native Hawaiian or Other Pacific Islander

White

Another option not listed here (please specify):

I prefer not to answer this question

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* 6. Which category best describes you?

Woman

Man

Transgender

Prefer to self-describe:

I prefer not to answer this question

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* 7. Which category best describes you?

Heterosexual

Bisexual

Gay

Lesbian

Prefer to self-describe:

I prefer not to answer this question

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* 8. What is the highest level of education you have completed?

Less than high school graduate

High school graduate (or equivalency)

Some college or associate's degree

Bachelor's degree or higher

I prefer not to answer this question

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* 9. What is your individual annual income?

$0-$9,999

$10,000-$19,999

$20,000-$29,999

$30,000-$39,999

$40,000-$49,999

$50,000-$59,999

$60,000-$69,999

$70,000-$79,999

$80,000-$89,999

$90,000-$99,999

$100,000 and above

I prefer not to answer this question

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* 10. What is your annual household income? Household income is the total income received by all members who live in your household.

$0-$40,770

$40,771-$54,930

$54,931-$69,090

$69,091-$83,250

$83,251-$97,410

$97,411-$111,570

$111,571-$125,730

$125,731-$139,890

$139,891-$154,050

$154,051-$168,210

$168,211 and above

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* 11. How many people live in your household, including yourself?

11 or more

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* 12. Do you qualify for benefits in your current job (if applicable)?

Yes

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* 13. All class graduates receive a free tshirt. Would you be interested in a shirt?

Yes

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* 14. What size t-shirt?

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* 15. What color t-shirt?

Blue

Gray