East Bay Meditation Center Survey

Thank you for taking the time to fill out this survey. The information collected will be used by EBMC to better understand the needs of our community.

We invite you to answer any questions that you feel apply to you, or that you'd like to provide feedback for. Your responses help shape the future of EBMC's programming and operations.

Your answers are anonymous. At the conclusion of the survey you’ll be given an opportunity to enter a raffle for various books by Jack Kornfield and Sylvia Boorstein, and gift certificates to Spice Monkey (restaurant near EBMC). Your name and email address will be kept separate from your survey answers.

Question Title

* What is your primary racial/ethnic identity?

Asian-American or Pacific Islander

Black/African-American

Arab-American

Latinx

Native American

White/Caucasian

Biracial/Multiracial

Please add any other identification not listed above:

Question Title

* What is your gender identity?

Cisgender Female (your gender identity matches your assigned sex at birth)

Cisgender Male (your gender identity matches your assigned sex at birth)

Genderqueer/Non-Binary/Third Gender

Intersex

Non-gendered

Transgender Female

Transgender Male

Two Spirit

Another gender identity not listed here (please specify).

Question Title

* What is your sexual orientation?

Asexual

Bisexual

Gay

Heterosexual

Lesbian

Pansexual

Queer

Same gender loving

Another sexual orientation not listed here (please specify).

Question Title

* Do you identify as a person with disabilities?

Yes

Question Title

* Please indicate your age range:

Under 18

18-24

25-34

35-44

45-54

55-64

65-74

75 or over

Question Title

* Please indicate the number of children (if any) you have in the following age ranges:

	One	Two	Three	Four	Five
Newborn - 4 years	Newborn - 4 years One	Newborn - 4 years Two	Newborn - 4 years Three	Newborn - 4 years Four	Newborn - 4 years Five
5 - 8 years old	5 - 8 years old One	5 - 8 years old Two	5 - 8 years old Three	5 - 8 years old Four	5 - 8 years old Five
9 - 13 years old	9 - 13 years old One	9 - 13 years old Two	9 - 13 years old Three	9 - 13 years old Four	9 - 13 years old Five
14 - 19 years old	14 - 19 years old One	14 - 19 years old Two	14 - 19 years old Three	14 - 19 years old Four	14 - 19 years old Five

Question Title

* Please indicate the range of your annual income:

a. Less than $20,000

b. $20,000 - $35,000

c. $35,000 - $50,000

d. $50,000 - $75,000

e. $75,000 - $100,000

f. $100,000 - $150,000

g. over $150,000

Question Title

* Please list your 5-digit zip code:

20% of survey complete.