NJA Diversity and Inclusivity Survey
1.
What is your gender identity?
Man
Woman
Genderqueer or non-binary
Agender
Not specified above. (Please comment below.)
  • Comment:

  • 500 characters left.
2.

Do you identify as transgender (or another non-cis gender identity)? 

Yes
No
3.

What is your sexual orientation? 

Asexual
Bisexual
Gay
Heterosexual or straight
Lesbian
Pansexual
Queer
None of the above. (Please specify below.)
  • Comment:

  • 500 characters left.
4.
What is your racial or ethnic identity? (Select all that apply.)
East Asian
Hispanic/Latinx
Middle Eastern
American Indian/Alaskan Native
Pacific Islander
South Asian
Southeast Asian
White
African American/Black
None of the above. (Please specify below.)
  • Comment:

  • 500 characters left.
5.

Are you a person living with a disability?  

Yes
No
6.

How old are you?

 

50 characters left.
7.

Is English your first language?

Yes
No
8.

What languages do you speak at home?

 

50 characters left.
9.
Do you identify with any of the following religions? (Please select all that apply.)
Protestantism
Catholicism
Christianity
Judaism
Islam
Buddhism
Hinduism
LDS
Native American
Inter/Non denominational
No religion
Other (Please specify below.)
  • Comment:

  • 500 characters left.
10.

Are you a parent or caretaker of children? 

Yes
No
11.

Are you a caretaker of adults? 

Yes
No
12.

Do you consider yourself a first generation college graduate?

Yes
No
13.

Have you ever served on active duty in the U.S. Armed Forces (includes activation from the Reserves or National Guard)?

Yes
No