1. What is your age?

2. What is your gender?

3. What is your race/ethnicity?

4. What is your ZIP code of residence?

5. How many people live in your household?

6. What is your current household income range?

7. Are you currently employed?

8. If yes, what is your job title and employer?

9. If not, when were you last employed?

10. What kind of work have you done in the past?

11. What are the biggest barriers you face in finding or keeping employment? (Select all that apply)

How responsive have we been to your questions or concerns about our products/services?

At what email address would you like to be contacted?

12. What is the highest level of education you’ve completed?

13. Do you have any certifications or licenses? If yes, please list them.

14. What skills do you have that you believe are valuable in the workplace?

15. Are you interested in starting your own business? (Yes/No/Maybe)

16. If yes, what type of business are you interested in starting?

17. What kind of support would help you most with starting a business?