Caltrans Real McCoy Fenders and Ramps Title VI Survey

The following information is being collected by the California Department of Transportation (Caltrans) in order to comply with Title VI of the Civil Rights Act of 1964, Nondiscrimination in Federally Assisted Programs. Please take a few moments to complete the following questions. The data that you provide will enable Caltrans to identify impacted residents and communities affected by the Federal-Aid Highway Program. Please check the appropriate boxes which best describe you. Submittal of this information is voluntary.

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* 1. What is your gender?

Female

Male

Other

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* 2. What is your age?

18 to 24

25 to 34

35 to 44

45 to 54

55 to 64

65 to 74

75 or older

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* 3. What is your race or ethnicity?

Asian

Black or African American

Hispanic or Latino

Middle Eastern or North African

Multiracial or Multiethnic

Native American or Alaska Native

Native Hawaiian or other Pacific Islander

White

Another race or ethnicity, please describe below

Self-describe below:

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* 4. Are you a person living with a disability?

Yes

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* 5. What language is primarily spoken in your household?

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* 6. What is your total household income?

$24,858 or less

More than $24,858