Family Demographics
1. Please enter the number (#)
of people living in your family, in each age group below. (please include
yourself)
# of infants (under 12 mo.)
# of toddlers (12 mo. - 2.9 yrs.)
# of preschoolers (3 - 5 yrs.)
# of children K-3rd grade (5 - 8
yrs.)
# of adolescents (9 - 21 yrs.)
# of adults (22 yrs and older)
2. Do any of your children have any
special needs requiring attenance at a special school or program?
If
yes, please list the ages of all children applicable.
age of child 1
age of child2
age of child3
age of child4
3. Which describes your family? (check
all that apply)
Other
4. Select the level of education both you and your
spouse or partner. (please select only one)
You
Less than high school
High School diploma or GED
Some college
College Degree
Graduate degree
Other
Other parent
Less than high school
High School diploma or GED
Some college
College Degree
Graduate degree
Other
5. Estimated yearly family income
before taxes (please only select from your family's category)
Family of 2
Below 11,610
11,611 - 23,220
23,221 - 27,283
27,284+
Family of 3
Below 14,630
14,631 - 29,260
29,261 - 34,381
34,382+
Family of 4
Below 17,650
17,651 - 35,300
35,301 - 41,477
41,478+
Family of 5
Below 20,670
20,671 - 41,340
41,341 - 48,574
48,575+
Family of 6
Below 23,690
23,691 - 47,380
47,381 - 55,671
55,672+
Family of 7
Below 26,710
26,711 - 53,420
53,421 - 62,768
62,769+
6. What Language do you use most in
your home?
7. If English is not used most, is
English also spoken?
Yes
Employment
8. Describe the current employment
of the adults living in your family
Yourself
Other parent
Other Adult
Employed more than 25 hours a week
Employed less than 25 hours a week
Self-employed
Not employed
Full-time student/traning program
Part-time student/training program
Seasonal Employment
Retired
Disabled
Employed more than 25 hours a week
Employed less than 25 hours a week
Self-employed
Not employed
Full-time student/traning program
Part-time student/training program
Seasonal Employment
Retired
Disabled
Employed more than 25 hours a week
Employed less than 25 hours a week
Self-employed
Not employed
Full-time student/traning program
Part-time student/training program
Seasonal Employment
Retired
Disabled
9. What are your hours of employment?
(include commute)
You
Other household adults
