GOPUSA -- Demographic Survey

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Thank you for your interest in joining the GOPUSA Grassroots Survey Team!

Please fill out the demographic survey below. If you are selected to be part of the GOPUSA Grassroots Survey Team, this information will be used to create your Member Profile.

All information is confidential and will never be used to identify you as an individual. Information will only be used collectively in demographic studies.

Required Information

First Name:
Last Name:
State:
ZIP Code:
Phone:	--
E-mail Address:
Confirm E-mail Address:

1. What is your age, please?

	18-24
	25-34
	35-44
	45-54
	55-64
	65-74
	75+
	Decline To Answer

2. Are you currently ...?

	Married
	Single
	Divorced
	Separated
	Widowed
	Decline To Answer

3. Do you have any children 18 years of age or younger living at home with you?

	Yes, 1
	Yes, 2
	Yes, 3 or more
	No
	Decline To Answer

4. Are you currently registered to vote as a Republican, Democrat, Independent or are you not registered at all?

	Republican
	Democrat
	Independent
	Unaffiliated
	Not Registered to Vote
	My State Does Not Register by Party
	Decline To Answer

5. In politics today, regardless of your political party registration, do you consider yourself to be a ...?

	Strong Republican
	Not-so-strong Republican
	Independent-leaning Republican
	Independent
	Independent-leaning Democrat
	Not-so-strong Democrat
	Strong Democrat
	Decline To Answer

6. Thinking for a moment about your political views, do you consider yourself to be ...?

	Very Conservative
	Somewhat Conservative
	Moderate
	Somewhat Liberal
	Very Liberal
	Libertarian
	Do Not Know
	Decline To Answer

7. Would you describe your racial or ethnic background as ...?

	White / Caucasian
	Black / African American
	Hispanic / Latino
	Native American
	Asian
	Middle Eastern
	Other
	Decline To Answer

8. Which of the following best describes your current employment status or occupation?

	Professional / Executive
	Small Business Owner
	White Collar / Administrative / Clerical
	Blue Collar / Service / Manufacturing
	Retired
	Stay At Home / Do Not Work
	Student
	Unemployed
	Other
	Decline To Answer

9. What is the last grade of formal education you completed?

	Less Than High School
	High School Graduate
	Some College / Vocational School
	College Graduate
	Post Graduate
	Decline To Answer

10. Which of the following media sources do you consider your primary source of news and information?

	A Local Newspaper
	A National Newspaper Such as USA Today
	Your Local Evening TV News
	Cable Television News Channels
	National Network Evening News
	Radio
	Internet
	All
	None
	Decline To Answer

11. In general, how often do you log onto the Internet?

	Every Hour
	A Few Times A Day
	Every Day
	A Few Days A Week
	About Once A Week
	A Few Times A Month
	A Couple of Times A Month
	About Once A Month
	Decline To Answer

12. In general, how often do you check your e-mail?

	Every Hour
	A Few Times A Day
	Every Day
	A Few Days A Week
	About Once A Week
	A Few Times A Month
	A Couple of Times A Month
	About Once A Month
	Decline To Answer

13. In general, how often to you listen to talk radio?

	Every Hour
	A Few Times A Day
	Every Day
	A Few Days A Week
	About Once A Week
	A Few Times A Month
	A Couple of Times A Month
	About Once A Month
	Never / Don't Listen To Talk Radio
	Decline To Answer

14. How would you describe the community in which you live?

	Urban
	Suburban
	Rural
	Do Not Know
	Decline To Answer

15. Are you ...?

	Catholic
	Protestant
	Jewish
	Agnostic / Atheist
	Muslim
	Mormon
	Other
	None / Unaffiliated
	Decline To Answer

16. If Christian, do you consider yourself to be born again or evangelical?

	Born Again
	Evangelical
	Neither
	Do Not Know
	Decline To Answer

17. Do you attend religious services ...?

	Daily
	Twice A Week
	About Once A Week
	Monthly
	Every Now and Then
	Only On Holidays / Special Occasions
	Never
	Decline To Answer

18. Do you currently hold any investments in stocks or stock mutual funds either directly or through a 401k or pension plan?

	Yes
	No
	Do Not Know
	Decline To Answer

19. Which of the following statements most closely reflects your position on the issue of abortion?

	Abortions Should Be Prohibited In All Circumstances
	Abortion Should Be Legal Only To Save The Life Of The Mother
	Abortions Should Only Be Legal In Cases Of Rape, Incest Or To Save The Life Of The Mother
	Abortions Should Be Legal For Any Reason, But Not After The First Three Months Of Pregnancy
	Abortions Should Be Legal For Any Reason, But Not After The First Six Months Of Pregnancy
	Abortions Should Be Allowed At Any Time During A Woman's Pregnancy And For Any Reason
	Do Not Know
	Decline To Answer

20. Do you, or does anyone in your home, own a firearm of any sort?

	Yes, I Own A Gun
	Yes, Someone Else In My Home Owns A Gun
	There Are No Guns In My Home
	Decline To Answer

21. Do you own or rent your home?

	Own
	Rent
	Decline To Answer

22. Which of the following best describes your health care coverage:

	My Employer Provides Health Care Coverage As Part Of My Job
	I Receive My Health Care Through My Spouse's Healthcare Coverage
	I Receive Veterans' Benefits
	I Receive Medicare Or Medicaid
	I Pay For My Health Insurance On My Own
	I Currently Do Not Have Health Insurance
	Decline To Answer

23. Which of the following categories best describes your family's annual income?

	Below $15,000
	$15,000 To $24,999
	$25,000 To $29,999
	$30,000 To $39,999
	$40,000 To $49,999
	$50,000 To $59,999
	$60,000 To $69,999
	$70,000 To $79,999
	$80,000 To $89,999
	$90,000 And Above
	Decline To Answer