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