* Indicates required questions.

0%

1. What is your relationship status? *

Married
Single
Engaged
Committed Relationship

2. How old are you? *

18 - 25
26 - 35
36 - 45
46 - 55
56 or older

3. What is your highest level of education? *

High School
Some College
Bachelor's Degree
Master's Degree
Doctorate

4. What is your annual household salary? *

Less than $25,000
$25,001 - $50,000
$50,001 - $75,000
$75,001 - $100,000
More than $100,000

5. Are you currently parenting a biological child? *

Yes
No

6. Are you currently parenting an adopted child? *

Yes
No

7. How interested are you in the following? *

	Not At All	Somewhat	Very
Domestic adoption
International adoption
Adopting from the state

8. What age range are you considering for the adopted child? *

0 - 1 years old
2 - 5
6 - 11
12 - 17
Older than 17

9. What level of communication would you like to have in the adoption? *

None
Very little
Some
A lot

10. What is your race or ethnicity? *

Asian, Asian-American or Pacific Islander
Hispanic
Black (Not Hispanic)
North American Indian or Alaskan Native
White (Not Hispanic)
Middle Eastern
Do not wish to disclose