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Welcome to the Youth Equity & Economic Mobility Community Survey
Address and age verification. You will be redirected to the survey after verification.
13
Questions
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1
Name
*
This field is required.
First Name
Last Name
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2
Mobile Verification
*
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To protect the integrity of this statewide research project and ensure survey incentives are distributed fairly, please verify a mobile number you can access. We will send a one-time verification code.
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3
Mobile Privacy Policy
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4
Do you live in Washington State.
*
This field is required.
YES
NO
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5
Current Residential Address
*
This field is required.
Enter the physical address where you currently live. Please select your address from the suggested results. Do not enter a workplace, school, business, organization, or P.O. Box.
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6
State/Province
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Please Select
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
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7
What county do you live in?
Please Select
Adams
Asotin
Benton
Chelan
Clallam
Clark
Columbia
Cowlitz
Douglas
Ferry
Franklin
Garfield
Grant
Grays Harbor
Island
Jefferson
King
Kitsap
Kittitas
Klickitat
Lewis
Lincoln
Mason
Okanogan
Pacific
Pend Oreille
Pierce
San Juan
Skagit
Skamania
Snohomish
Spokane
Stevens
Thurston
Wahkiakum
Walla Walla
Whatcom
Whitman
Yakima
Please Select
Please Select
Adams
Asotin
Benton
Chelan
Clallam
Clark
Columbia
Cowlitz
Douglas
Ferry
Franklin
Garfield
Grant
Grays Harbor
Island
Jefferson
King
Kitsap
Kittitas
Klickitat
Lewis
Lincoln
Mason
Okanogan
Pacific
Pend Oreille
Pierce
San Juan
Skagit
Skamania
Snohomish
Spokane
Stevens
Thurston
Wahkiakum
Walla Walla
Whatcom
Whitman
Yakima
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8
Does your residence have an apartment, unit, suite, room, or building number?
*
This field is required.
YES
NO
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9
If you selected YES, enter the information below. If you selected NO put "N/A"
*
This field is required.
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10
You must be ages 16-24 to participate in this survey. Please choose an option.
*
This field is required.
Please Select
I am currently age 16-24.
I am Under age 16.
I am over age 24.
Please Select
I am currently age 16-24.
I am Under age 16.
I am over age 24.
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11
What is your Date of Birth?
*
This field is required.
-
Date
Month
Day
Year
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12
Signature
*
This field is required.
This signature verifies that information you provided is true and accurate. Upon additional checks if we flag this information as invalid or false you forfeit any opportunity to receive a monetary incentive for filling out our form due to fraud. If all the information provided is valid, please sign.
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13
Please verify that you are human
*
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14
Verified_Phone_Key
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15
Participant_Key
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16
AGE_CALCULATED
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17
Duplicate_Key
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18
ADDRESS_REVIEW
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19
COUNTY_REVIEW
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20
FRAUD_SCORE
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21
SCREEN_STATUS
PASS
REVIEW
BLOCK
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22
Review_Reason
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