Demographic Survey for EcoCart

We invite you to complete this optional survey to help us evaluate our diversity and inclusion efforts. Submission of the information on this form is strictly voluntary and refusal to provide it will not subject you to any adverse treatment or affect your job application. Information obtained will be kept separate from your name or job application. This information will be kept secure and confidential and will be used solely to evaluate our diversity and inclusion efforts.

• What is your age range?
  • 17 or younger
  • 18-20
  • 21-29
  • 30-39
  • 40-49
  • 50-59
  • 60 or older
• To what racial/ethnic groups do you belong?

  Select all that apply

  • White / Caucasian
  • Hispanic
  • Black or African American
  • Asian
  • Native Hawaiian or other Pacific Islander
  • Indigenous Peoples, First Nations, Native American, or Alaska Native
  • Other
• How do you describe your gender identity?

  Select all that apply

  • Man
  • Non-Binary
  • Woman
  • Other
• Do you identify as a member of the LGBTQIA+ community?
  • Yes
  • No
• Do you identify as a person with a disability and/or as a person with accessibility needs?
  • Yes
  • No