New Survey

Survey 1: What is Your Relationship with Democracy?/ NO LABELS -Just tell us how you feel.

1. Is democracy the best way for citizens to enjoy freedom in society?

Very Dissatisfied	Dissatisfied	Neutral	Satisfied	Very Satisfied
Very Dissatisfied	Dissatisfied	Neutral	Satisfied	Very Satisfied

Comment:

2. How can democracy change for the better?

3. What can you give back to democracy that will make it better? *This question is required.

4. Age

5. Ethnicity

6. Country of Origin

7. Country You Live in Now

8. Income level (High/Upper Middle/Middle/Low)

9. I want to be Anonymous

10. I want to talk about this in detail:
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Email:

11. Consent
I agree to providing the information in this survey. I understand that the results will be utilized in a journalistic, media based or literary publication. All information will be treated confidentially and maintained in a secure manner. Subjects who wish to provide additional input and are willing to allow their identities be become public will be contacted for additional consent.

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