Head of Household Person 2 Person 3 Person 4 Person 5 Are you Hispanic Yes Yes Yes Yes Yes ⃝ ⃝ ⃝ ⃝ ⃝ or Latino? No No No No No ⃝ ⃝ ⃝ ⃝ ⃝ Doesn’t Know Doesn’t Know Doesn’t Know Doesn’t Know Doesn’t Know ⃝ ⃝ ⃝ ⃝ ⃝ Refused Refused Refused Refused Refused ⃝ ⃝ ⃝ ⃝ ⃝ Which gender Male Male Male Male Male ⃝ ⃝ ⃝ ⃝ ⃝ identity do you Female Female Female Female Female most identify ⃝ ⃝ ⃝ ⃝ ⃝ with? Trans Male to Female Trans Male to Female Trans Male to Female Trans Male to Female Trans Male to Female ⃝ ⃝ ⃝ ⃝ ⃝ Female to Male Trans Female to Male Trans Female to Male Trans Female to Male Trans Female to Male ⃝ ⃝ ⃝ ⃝ ⃝ Gender Non- Gender Non- Gender Non- Gender Non- Gender Non- ⃝ ⃝ ⃝ ⃝ ⃝ Conforming Conforming Conforming Conforming Conforming Non-Binary Non-Binary Non-Binary Non-Binary Non-Binary ⃝ ⃝ ⃝ ⃝ ⃝ Doesn’t Know Doesn’t Know Know Doesn’t Know Doesn’t Know ⃝ ⃝ ⃝ ⃝ ⃝ Refused Refused Refused Refused Refused ⃝ ⃝ ⃝ ⃝ ⃝ Which of the Lesbian or Gay Lesbian or Gay Lesbian or Gay Lesbian or Gay Lesbian or Gay ⃝ ⃝ ⃝ ⃝ ⃝ following best Straight Straight Straight Straight Straight ⃝ ⃝ ⃝ ⃝ ⃝ represents how Bisexual Bisexual Bisexual Bisexual Bisexual ⃝ ⃝ ⃝ ⃝ ⃝ you think of Something Else Something Else Something Else Something Else Something Else yourself? ⃝ ⃝ ⃝ ⃝ ⃝ Doesn’t Know Doesn’t Know Doesn’t Know Doesn’t Know Doesn’t Know ⃝ ⃝ ⃝ ⃝ ⃝ Refused Refused Refused Refused Refused ⃝ ⃝ ⃝ ⃝ ⃝ Are you currently Yes Yes Yes Yes Yes ⃝ ⃝ ⃝ ⃝ ⃝ experiencing an No No No No No ⃝ ⃝ ⃝ ⃝ ⃝ abusive Doesn’t Know Know Doesn’t Know Doesn’t Know Doesn’t Know ⃝ ⃝ ⃝ ⃝ ⃝ relationship? Refused Refused Refused Refused Refused ⃝ ⃝ ⃝ ⃝ ⃝ Head of Household Person 2 Person 3 Person 4 Person 5 Are you currently Currently Employed Currently Employed Currently Employed Currently Employed Currently Employed ⃝ ⃝ ⃝ ⃝ ⃝ employed or Attending School Attending School Attending School Attending School Attending School ⃝ ⃝ ⃝ ⃝ ⃝
Head of Household Person 2 Person 3 Person 4 Person 5 Are you Hispanic or Latino? ⃝ Yes ⃝ No ⃝ Doesn’t Know ⃝ Refused ⃝ Yes ⃝ No ⃝ Doesn’t Know ⃝ Refused ⃝ Yes ⃝ No ⃝ Doesn’t Know ⃝ Refused ⃝ Yes ⃝ No ⃝ Doesn’t Know ⃝ Refused ⃝ Yes ⃝ No ⃝ Doesn’t Know ⃝ Refused Which gender identity do you most identify with? ⃝ Male ⃝ Female ⃝ Trans Male to Female ⃝ Female to Male ⃝ Gender Non- Conforming ⃝ Non-Binary ⃝ Doesn’t Know ⃝ Refused ⃝ Male ⃝ Female ⃝ Trans Male to Female ⃝ Trans Female to Male ⃝ Gender Non- Conforming ⃝ Non-Binary ⃝ Doesn’t Know ⃝ Refused ⃝ Male ⃝ Female ⃝ Trans Male to Female ⃝ Trans Female to Male ⃝ Gender Non- Conforming ⃝ Non-Binary ⃝ Know ⃝ Refused ⃝ Male ⃝ Female ⃝ Trans Male to Female ⃝ Trans Female to Male ⃝ Gender Non- Conforming ⃝ Non-Binary ⃝ Doesn’t Know ⃝ Refused ⃝ Male ⃝ Female ⃝ Trans Male to Female ⃝ Trans Female to Male ⃝ Gender Non- Conforming ⃝ Non-Binary ⃝ Doesn’t Know ⃝ Refused Which of the following best represents how you think of yourself? ⃝ Lesbian or Gay ⃝ Straight ⃝ Bisexual ⃝ Something Else ⃝ Doesn’t Know ⃝ Refused ⃝ Lesbian or Gay ⃝ Straight ⃝ Bisexual ⃝ Something Else ⃝ Doesn’t Know ⃝ Refused ⃝ Lesbian or Gay ⃝ Straight ⃝ Bisexual ⃝ Something Else ⃝ Doesn’t Know ⃝ Refused ⃝ Lesbian or Gay ⃝ Straight ⃝ Bisexual ⃝ Something Else ⃝ Doesn’t Know ⃝ Refused ⃝ Lesbian or Gay ⃝ Straight ⃝ Bisexual ⃝ Something Else ⃝ Doesn’t Know ⃝ Refused Are you currently experiencing an abusive relationship? ⃝ Yes ⃝ No ⃝ Doesn’t Know ⃝ Refused ⃝ Yes ⃝ No ⃝ Know ⃝ Refused ⃝ Yes ⃝ No ⃝ Doesn’t Know ⃝ Refused ⃝ Yes ⃝ No ⃝ Doesn’t Know ⃝ Refused ⃝ Yes ⃝ No ⃝ Doesn’t Know ⃝ Refused Head of Household Person 2 Person 3 Person 4 Person 5 Are you currently employed or ⃝ Currently Employed ⃝ Attending School ⃝ Currently Employed ⃝ Attending School ⃝ Currently Employed ⃝ Attending School ⃝ Currently Employed ⃝ Attending School ⃝ Currently Employed ⃝ Attending School
2018-Working-Youth-Survey-1.docx