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Gender?
 
Male
 
Female
 
 
 
How often do you conduct surveys?
 
Weekly
 
Monthly
 
Quarterly
 
Annually
 
 
 
Your Age
   
 
 
 
What is your date of birth?
MonthDayYear
  
 
 
 
How would you describe your marital status?
 
Single
 
Married
 
Divorced
 
Widowed
 
Living with partner
 
Other
 
 
 
 
What is your date of birth?
MonthDayYear
  
 
 
 
How would you describe your marital status?
 
Single
 
Married
 
Divorced
 
Widowed
 
Living with your future spouse
 
Other
 
 
 
How would you describe your race?
 
African
 
Coloured
 
White
 
Asian
 
Other (specify)
 
 
 
How would you describe your place of residence?
 
Urban formal
 
Urban informal
 
Rural informal
 
Other (specify)
 
 
 
How would you describe your place of residence?
 
Urban formal
 
Urban informal
 
Rural informal
 
Other (specify)
 
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