CISV USA Census - CISV USA

How do you self-identify?*
- Asian
- Black/African American
- Hispanic or Latino
- Native American/Alaskan Native
- Native Hawaiian or Pacific Islander
- White
- Multiracial, Biracial
- A racial/ethnic category not listed
- Prefer not to say
What gender do you identify with?*
- Woman
- Man
- Prefer not to say
- Self Identify
Gender Self Identification
Do you consider yourself to be*
- Heterosexual or straight
- Not Heterosexual or straight
- Prefer not to say
- Self Identify
Self Identification
What is your age?*
- under 18
- 18-29
- 30-45
- 45+
- Prefer not to say
If you are currently a student (K-12), is your school:*
- Private
- Public
- Homeschooled
- N/A
- Prefer not to say
What is your household income bracket? (Why are we asking this? CISV can use household income to inform allocation decisions and apply for grants to improve your CISV experience!)*
- I am under 18 yrs old
- $0 - $40,000
- $40,000 - $100,000
- $100,000 - $250,000
- $250,000+
- Prefer not to say
I am a person (check all that apply):*
- who is blind or with low vision
- who is mute or uses a device to speak
- who is deaf or hard of hearing
- with an intellectual or cognitive disability
- with a learning disability
- with a physical disability or mobility impairment
- with an emotional or behavioral disability
- without a disability
- Prefer not to say
What chapter are you from?*
When was the last time you participated in a CISV activity or were otherwise actively involved in the organization?*
- Currently Active
- Within the last 3 years
- Within the last 5 years
- More than 5+ years ago
How did you hear about CISV USA?*
- Through CISV outreach
- Through a family member
- Through a friend
- Through school
- Through the internet
- Prefer not to say
Any feedback/suggestions for the Diversity, Equity, Inclusion, & Accessibility (DEIA) committee?*
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