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First Name*
Last Name*
Phone Number*
Email Address*
Age*
-- select one --
0 - 14 years old
15 - 29 years old
30 - 44 years old
45 - 64 years old
65+
Sex*
-- select one --
Male
Female
Marital Status*
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Single
Engaged
Married
Divorced
Ethnicity*
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Caucasian
African-American
Latino or Hispanic
Asian
Native American
Native Hawaiian or Pacific islander
Two or more
Other/Unknown
Prefer not to say
Occupation*
-- select one --
- Senior Pastor
- Worship Pastor
- Executive Pastor
- Associate Pastor
- Children's Pastor
- Youth or Student Pastor
- College or Young Adults Pastor
- Adult Ministry Pastor
- Administrative or Operations Pastor
- Teaching Pastor
- Campus Pastor
- Family Pastor
- Media & Communications Director
- Women Director
- Small Groups or Spiritual Formation Pastor
- Executive Director
- Chief Operating Officer
- Business Advancement
- Chiropractor
- Dentist
- Dietitian or Nutritionist
- Optometrist
- Pharmacist
- Physician
- Physician Assistant
- Podiatrist
- Registered Nurse
- Therapist
- Veterinarian
- Health Technologist or Technician
- Other Healthcare Practitioners and Technical Occupation
- Nursing, Psychiatric, or Home Health Aide
- Occupational and Physical Therapist Assistant or Aide
- Other Healthcare Support Occupation
- Chief Executive
- General and Operations Manager
- Advertising, Marketing, Promotions, Public Relations, and Sales Manager
- Operations Specialties Manager (e.g., IT or HR Manager)
- Construction Manager
- Engineering Manager
- Accountant, Auditor
- Business Operations or Financial Specialist
- Business Owner
- Other Business, Executive, Management, Financial Occupation
- Architect, Surveyor, or Cartographer
- Engineer
- Other Architecture and Engineering Occupation
- Postsecondary Teacher (e.g., College Professor)
- Primary, Secondary, or Special Education School Teacher
- Other Teacher or Instructor
- Other Education, Training, and Library Occupation
- Arts, Design, Entertainment, Sports, and Media Occupations
- Computer Specialist, Mathematical Science
- Counselor, Social Worker, or Other Community and Social Service Specialist
- Lawyer, Judge
- Life Scientist (e.g., Animal, Food, Soil, or Biological Scientist, Zoologist)
- Physical Scientist (e.g., Astronomer, Physicist, Chemist, Hydrologist)
- Religious Worker (e.g., Clergy, Director of Religious Activities or Education)
- Social Scientist and Related Worker
- Other Professional Occupation
- Supervisor of Administrative Support Workers
- Financial Clerk
- Secretary or Administrative Assistant
- Material Recording, Scheduling, and Dispatching Worker
- Other Office and Administrative Support Occupation
- Protective Service (e.g., Fire Fighting, Police Officer, Correctional Officer)
- Chef or Head Cook
- Cook or Food Preparation Worker
- Food and Beverage Serving Worker (e.g., Bartender, Waiter, Waitress)
- Building and Grounds Cleaning and Maintenance
- Personal Care and Service (e.g., Hairdresser, Flight Attendant, Concierge)
- Sales Supervisor, Retail Sales
- Retail Sales Worker
- Insurance Sales Agent
- Sales Representative
- Real Estate Sales Agent
- Other Services Occupation
- Construction and Extraction (e.g., Construction Laborer, Electrician)
- Farming, Fishing, and Forestry
- Installation, Maintenance, and Repair
- Production Occupations
- Other Agriculture, Maintenance, Repair, and Skilled Crafts Occupation
- Aircraft Pilot or Flight Engineer
- Motor Vehicle Operator (e.g., Ambulance, Bus, Taxi, or Truck Driver)
- Other Transportation Occupation
- Military
- Homemaker
- Other Occupation
- Don't Know
- Not Applicable
Highest Level of Education*
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No formal education
Primary education
Secondary education or high school
GED
Vocational qualification
Bachelor's degree
Master's degree
Doctorate or higher
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