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* 1. How many adults and how many children are in the household and what are their ages?

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Adults: Age 16 - 25
 Adults: Age 26 - 34
Adults: Age 35 – 44
Adults: Age 45 - 54,
Adults: Age 55 – 64,
Adults: Age 65+
Children: Age 0-4
Children: Age 5-11 
Children: Age 12-15

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* 2. What is your gender:

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* 3. Is your gender identity the same as the gender you were assigned at birth?

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* 4. Are you married or in a civil partnership?

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* 5. Do you consider yourself to be disabled?

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