Simply Parent Survey

What is your gender?

• Male
• Female
• Other - Write In (Required) Please enter an 'other' value for this selection.

What is your sexual orientation?

• Heterosexual
• Lesbian/Gay
• Bisexual
• Other - Write In (Required) Please enter an 'other' value for this selection.

What is your current marital status?

• Married / Domestic Partner
• Widowed
• Divorced
• Legally Separated
• Single / Never Married
• Other - Write In (Required) Please enter an 'other' value for this selection.

What is your approximate yearly household income in U.S. dollars (including all sources)?

To covert from another currency, you can use this link: http://www.xe.com/currencyconverter/

• Less than $15,000
• $15,000 to $25,000
• $25,001 to $40,000
• $40,001 to $60,000
• $60,001 to $80,000
• $80,001 to $100,000
• $100,001 to $120,000
• $120,001 to $140,000
• $140,001 to $160,000
• Over $160,000

What is the highest level of education you have completed?

Less than high school	Graduated high school	Trade/technical school	Some college, no degree	Associate degree	Bachelor's degree	Advanced degree (Master's, Ph.D., J. D., M.D.)
Less than high school	Graduated high school	Trade/technical school	Some college, no degree	Associate degree	Bachelor's degree	Advanced degree (Master's, Ph.D., J. D., M.D.)

What racial group do you most closely identify with? (select all that  apply)

• White
• Black
• Asian
• Native American or Alaskan Native
• Native Hawaiian or Pacific Islander
• Other - Write In (Required) Please enter an 'other' value for this selection. * This question is required.

Are you Hispanic/Latina or Latino?

• Yes
• No