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Please fill out the demographic survey below. If you are selected to be part of the GOPUSA Grassroots Survey Team, this information will be used to create your Member Profile.

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1. What is your age, please?

18-24
25-34
35-44
45-54
55-64
65-74
75+
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2. Are you currently ...?

Married
Single
Divorced
Separated
Widowed
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3. Do you have any children 18 years of age or younger living at home with you?

Yes, 1
Yes, 2
Yes, 3 or more
No
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4. Are you currently registered to vote as a Republican, Democrat, Independent or are you not registered at all?

Republican
Democrat
Independent
Unaffiliated
Not Registered to Vote
My State Does Not Register by Party
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5. In politics today, regardless of your political party registration, do you consider yourself to be a ...?

Strong Republican
Not-so-strong Republican
Independent-leaning Republican
Independent
Independent-leaning Democrat
Not-so-strong Democrat
Strong Democrat
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6. Thinking for a moment about your political views, do you consider yourself to be ...?

Very Conservative
Somewhat Conservative
Moderate
Somewhat Liberal
Very Liberal
Libertarian
Do Not Know
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7. Would you describe your racial or ethnic background as ...?

White / Caucasian
Black / African American
Hispanic / Latino
Native American
Asian
Middle Eastern
Other
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8. Which of the following best describes your current employment status or occupation?

Professional / Executive
Small Business Owner
White Collar / Administrative / Clerical
Blue Collar / Service / Manufacturing
Retired
Stay At Home / Do Not Work
Student
Unemployed
Other
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9. What is the last grade of formal education you completed?

Less Than High School
High School Graduate
Some College / Vocational School
College Graduate
Post Graduate
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10. Which of the following media sources do you consider your primary source of news and information?

A Local Newspaper
A National Newspaper Such as USA Today
Your Local Evening TV News
Cable Television News Channels
National Network Evening News
Radio
Internet
All
None
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11. In general, how often do you log onto the Internet?

Every Hour
A Few Times A Day
Every Day
A Few Days A Week
About Once A Week
A Few Times A Month
A Couple of Times A Month
About Once A Month
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12. In general, how often do you check your e-mail?

Every Hour
A Few Times A Day
Every Day
A Few Days A Week
About Once A Week
A Few Times A Month
A Couple of Times A Month
About Once A Month
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13. In general, how often to you listen to talk radio?

Every Hour
A Few Times A Day
Every Day
A Few Days A Week
About Once A Week
A Few Times A Month
A Couple of Times A Month
About Once A Month
Never / Don't Listen To Talk Radio
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14. How would you describe the community in which you live?

Urban
Suburban
Rural
Do Not Know
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15. Are you ...?

Catholic
Protestant
Jewish
Agnostic / Atheist
Muslim
Mormon
Other
None / Unaffiliated
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16. If Christian, do you consider yourself to be born again or evangelical?

Born Again
Evangelical
Neither
Do Not Know
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17. Do you attend religious services ...?

Daily
Twice A Week
About Once A Week
Monthly
Every Now and Then
Only On Holidays / Special Occasions
Never
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18. Do you currently hold any investments in stocks or stock mutual funds either directly or through a 401k or pension plan?

Yes
No
Do Not Know
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19. Which of the following statements most closely reflects your position on the issue of abortion?

Abortions Should Be Prohibited In All Circumstances
Abortion Should Be Legal Only To Save The Life Of The Mother
Abortions Should Only Be Legal In Cases Of Rape, Incest Or To Save The Life Of The Mother
Abortions Should Be Legal For Any Reason, But Not After The First Three Months Of Pregnancy
Abortions Should Be Legal For Any Reason, But Not After The First Six Months Of Pregnancy
Abortions Should Be Allowed At Any Time During A Woman's Pregnancy And For Any Reason
Do Not Know
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20. Do you, or does anyone in your home, own a firearm of any sort?

Yes, I Own A Gun
Yes, Someone Else In My Home Owns A Gun
There Are No Guns In My Home
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21. Do you own or rent your home?

Own
Rent
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22. Which of the following best describes your health care coverage:

My Employer Provides Health Care Coverage As Part Of My Job
I Receive My Health Care Through My Spouse's Healthcare Coverage
I Receive Veterans' Benefits
I Receive Medicare Or Medicaid
I Pay For My Health Insurance On My Own
I Currently Do Not Have Health Insurance
Decline To Answer

23. Which of the following categories best describes your family's annual income?

Below $15,000
$15,000 To $24,999
$25,000 To $29,999
$30,000 To $39,999
$40,000 To $49,999
$50,000 To $59,999
$60,000 To $69,999
$70,000 To $79,999
$80,000 To $89,999
$90,000 And Above
Decline To Answer

24. Are you ...?

Male
Female
Decline To Answer
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