Atlanta Focus Group Questionnaire
Full Legal Name
Street Address
City, State, Zip Code
Email
example@example.com
Preferred Contact Number
1. Age: What is your age?
a. 18-25
b. 25-30
c. 30-35
d. 35 or older
2. Ethnicity(or Race): Please specify your ethnicity
a. Nonresident Alien
b. Hispanics of any race
c. American Indian or Alaska Native
d. Asian
e. Black or African American
f. Native Hawaiian or Other Pacific Islander
g. White
h. Two or more races
i. Race and Ethnicity Unknown
j. Other(please specify)
k. Prefer not to respond
3. Gender: What is your gender?
a. Male
b. Female
c. Transgender
d. Other
e. Prefer not to respond
4.Employment Status
a.Full time
b. Part-time
c.Unemployed
d. Self employed
5.Occupation and Position (if applicable)
6.Marital Status: What is your marital status?
Single
In a relationship
Married
Separated
Divorced
Widowed
Submit
Should be Empty: