1.What is your age range?

18-24

25-34

35-44

45-54

55-64

65+

2.How do you identify your gender?

Male

Female

Non-binary

Prefer Not To Answer

Other (please specify)

3.What is your ethnic background?

African American/Black

Hispanic/Latino

Asian/Pacific Islander

Native American/Indigenous

Multiracial

Other (please specify)

4.What is your highest level of education completed?

Less than high school

High school diploma or GED

Some college

Associate degree

Bachelor's degree

Master's degree of higher

5.What is your annual household income?

Less than $20,000

$20,000-$39,999

$40,000-$59,999

$60,000-$79,999

$80,000-$99,999

$100,000+

Prefer not to answer

6.Zip code of residence

7.If you were a part of Samaritan Health Project, what would be your focus?

8.If you have any other thoughts regarding health in our community, please share