DFW Muslim Demographic Survey

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Age *

Sex *

Male

Female

Job Profession *

Employment *

Check all that apply

Unemployed

Part-time

Full-time

Retired

Student

Required

Annual Income *

Less than $20,000

$20,000 - $39,999

$40,000 - $59,999

$60,000 - $79,999

$80,000 - $99,999

$100,000 - $119,999

$120,000 - $139,999

$140,000 +

Highest level of education achieved *

GED

High School Diploma

Associates Degree

Undergraduate Degree

Graduate Degree

PhD, JD, PsyD, etc

Other:

Marital Status *

Single

Engaged

Married

Divorced

Widowed

How many children do you have? *

In what country were you born? *

Example: America, Turkey, Jordan, Thailand, Saudi Arabia

What is your ethnicity? *

Example: Arab, Persian, Gurjar, Pashtun

What languages can you speak fluently? *

If you are fluent in more than one language, what was the first language you learned?

City of Residence *

Mosque you attend *

How often do you attend the mosque? *

If daily, monthly, or occasionally, please specify in the next question

Daily

Every Friday

Monthly

Occasionally

Only on religious holidays

Never

If you chose daily, monthly, or occasionally in the last question, please specify here.

Example: 2 times a month

I am a . . . *

If not a citizen, please skip down to number 19

Citizen

Legal resident

Other:

If you are a citizen, are you registered to vote? *

Yes

Do you intend to vote in the next 2016 Presidential election? *

Yes

How important do you think voting in local elections are? *

Not important

Somewhat important

Very important

How important do you think voting in state elections are? *

Not important

Somewhat important

Very important

How important do you think voting in federal elections are? *

Not important

Somewhat important

Very important

I identify myself as part of the. . . *

Republican party

Democratic party

Independent party

Libertarian party

Green party

Constitution party

None

Other:

Please mark the one that applies *

I was born into a Muslim family

I am a convert to Islam

I am a revert to Islam

I consider myself a . . . *

Devout Muslim

Practicing Muslim

Non-practicing Muslim

Other:

If you consider yourself a Muslim, how would you categorize yourself? *

Sunni

Shia

Sufi

Just a Muslim

Ahmadi

Ismaili

Other:

Do you pay your zakat every year (when eligible)? *

Yes

N/A

If you donate to sadaqa, in what forms do you give? *

Example: material goods, monetary services, etc

Have you experienced any types of discrimination or bullying that you believe is a result of your religion or ethnicity? *

If yes, please specify in the next two questions.

Yes

If you have experienced any types of discrimination or bullying that you believe is a result of your religion or ethnicity, did you report it to CAIR-DFW or any other law enforcement or civil rights organization? *

Yes

If you have experienced any types of discrimination or bullying that you believe is a result of your religion or ethnicity, please briefly specify the occurrence. *

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