Name
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First Name
Last Name
Email
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Phone
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Your Caregiving Role
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Research Consent
Your Note to Dr. Olson
CGQ_FEEDBACK
Gender
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Female
Male
Non-binary
Ethnicity
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Asian
African American
Latino
Native American
Other Pacific Islander
White
Multi-ethnic
Other
Education
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Less than high school
High school diploma or GED
Some college
Associate degree
Bachelor's degree
Master's degree
Doctorate or professional degree (PhD, MD, JD, etc.)
Employment Status
Employed full-time
Employed part-time
Self-employed
Professional caregiver
Unemployed and looking for work
Unemployed and not looking for work
Retired
Student
Other
Income Level Annually
Less than $20,000
$20,000 to $59,999
$60,000 to $100,000
Over $100,000
Relationship Status
Single, never married
Married or domestic partnership
Divorced
Widowed
Separated
Prefer not to say
What state/country do you live in?
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Religion/Spirituality
Not spiritual/religious
Actively attend place religious/spiritual gathering
Actively practicing, without attending a gathering
Agnostic
Other