Demographic Survey Questions



Community Mediation Case Demographic Information

Please note: This information is completely anonymous and will be used for statistical purposes only. We are required to ask for the information requested below by one of our major funders, the Maryland Mediation and Conflict Resolution Office. It will be used for assessing and improving services and for supporting requests for funding. Thank you for your assistance.

1. Gender: Female Male

2. Age: 19 and under 20-29 30-39 40-49 50-59 60+

3. Race/Ethnic Group: (Check all that apply)

 Hispanic/ Latino American Indian/ Alaskan Native Asian

Black/African American Native Hawaiian/ Pacific Islander White

4. Education (highest level achieved):

1st-8th grade High school/GED degree 2-yr college degree/Professional certificate 4-yr college degree Graduate degree

5. Household Income:

Up to $14,999 $15,000-$24,999 $25,000-$34,999

$35,000-$49,999 $50,000-$74,999 $75,000-$99,999

$100,000-$149,999 $150,000-$199,999 $200,000+

6. Active Military: Yes No

Military Veteran: Yes No

7. ZIP code: _____________

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