myHIVrisk™ Assessment Survey

To help us better understand whom we are reaching and serving, we need some basic information from you before moving on to the assessment. There is no way for us to know who you are or locate your e-mail address. You will never be solicited or contacted based upon this information.

Your Personal Demographics

Please answer the following questions:
Sex: Male    Female    Transgender Male    Transgender Female   

Age: 
Zip Code:

Race/Ethnicity:
African-American
African
Asian/Pacific Islander
Caucasian
Hispanic
Multiracial
Native American/Alaskan
Other 

Educational Level:
Did Not Graduate High School
High School Diploma
Associate Degree
4-Year College Degree
Advanced Degree

Family Size: (number of people currently living in household)

Approximate Income:
(Remember, this survey is strictly confidential. There is no way for us to know who you are.)
Under $10,000/yr
$10-$20,000/yr
$21-$30,000/yr
$31-$40,000/yr
$41-$50,000/yr
over $50,000/yr

Employment Status:
Employed Full-Time
Employed Part-Time
Full-Time Student
Full-Time Homemaker
On Disability
Retired
Unemployed

Religious Preference: (optional)
Agnostic
Atheist
Buddhist
Christian
Hindu
Jewish
Muslim
Sikh
Other