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Demographic Questions
Which category best describes your caregiving relationship?
(Required)
Biological parent
Relative caregiver (grandparent, aunt, uncle, etc.)
Resource caregiver (foster parent)
Residential placement worker
None of the above
I prefer not to answer
Please select your age range
(Required)
18-24
25-34
35-44
45+
I prefer not to answer
Please select the racial identity that best describes you
(Required)
Latino/a/x/Hispanic
Black/African-American
White
Asian/Asian-American
Native Hawaiian/Pacific Islander
Native American/Alaskan Native
Middle Eastern/North African
Multi-ethnic/multi-racial
I prefer not to answer
What is the primary language you speak at home?
(Required)
Amharic
Arabic
Armenian
Cambodian
Chinese – Cantonese
Chinese – Mandarin
Other Chinese
English
Farsi
French Creole
Hindi
Hmong
Japanese
Korean
Laotian
Punjabi
Russian
Samoan
Somali
Spanish
Tagalog
Thai
Tongan
Twi
Vietnamese
None of the above
I prefer not to answer
What are your pronouns?
(Required)
She/her
He/him
They/Them
None of the above
I prefer not to answer
What term best describes your sexual orientation?
(Required)
Bisexual
Gay
Lesbian
Queer
Straight/heterosexual
None of the above
I prefer not to answer
Do you subscribe to any particular faith or religion?
(Required)
Agnostic
Atheist
Buddhist
Christian
Hindu
Jewish
Muslim
Sikh
Spiritism
Unitarian
Indigenous
None of the above
I prefer not to answer
What best describes your current relationship status?
(Required)
Single
Married
Widowed
Divorced, Single
Divorced, Remarried
Separated
In a relationship, living together
In a relationship, not living together
None of the above
I prefer not to answer
What is your annual household income?
(Required)
Less than $44,999
$45,000 to $139,999
$140,000 to $149,999
$150,000 or above
I prefer not to answer
What is your highest level of education you have completion
(Required)
Less than 9th grade
9th – 12th grade
High school graduate or GED
Some college, no degree
Associate degree
Bachelor’s degree
Master’s Degree
Doctorate Degree
Professional Degree
I prefer not to answer
What is the best description for your current occupation?
(Required)
Business and Financial operations
Computer and mathematical
Architecture and engineering
Life, physical, and social science
Community and social service
Legal
Educational instruction and library
Arts, design, entertainment, sports, and media
Healthcare practitioners and technical
Healthcare support (e.g., nursing assistant, orderly)
Building and grounds cleaning and maintenance
Personal care and service
Sales and related
Office and administrative support
Farming, fishing, and forestry
Construction and extraction
Installation, maintenance, and repair
Production (e.g., structural metal fabricator and fitter, laundry and dry-cleaning worker)
Transportation
Material moving (e.g., Crane and tower operator, stocker and order filler)
Unemployed
None of the above
I prefer not to answer
How many children do you have?
(Required)
What are the age ranges of your children?
(Required)
If none, please write n/a
How many children are living with you?
(Required)
Have you any familiarity with youth who may have a history of sexual exploitation?
(Required)
Yes
No
I prefer not to answer
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