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Issues and Voting Survey Fall 2019
Students: Please fill out one separate survey for each person you speak with.
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Email
*
Your email
Name of Student Conducting Survey
Your answer
Government Class
Period 1
Period 2
Period 7
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Name of Person Surveyed (First Name Only)
Your answer
Date of Survey
MM
/
DD
/
YYYY
Time of Survey
Time
:
AM
PM
What are three important issues in your community that you think local government officials should address?
Your answer
Why are you concerned about these issues? What do you think should be done?
Your answer
Which political party to do you prefer?
Democrats
Republicans
None
Other:
Clear selection
Did you vote in the 2016 presidential election?
Yes
No
Not eligible
Clear selection
If you voted in 2016 and are comfortable sharing, who did you vote for? (Skip this question if you did not vote in 2016.)
Trump
Clinton
Other
Clear selection
Did you vote in the election for mayor of New York City in 2017?
Yes
No
Not eligible
Clear selection
Did you vote in any primary or mid-term elections in 2018?
Yes
No
Not eligible
Clear selection
Did you vote or are you planning to vote on November 5, 2019?
Yes
No
Not eligible
Clear selection
Are you planning to vote in the presidential election in 2020?
Yes
No
Not sure
Not eligible
Clear selection
What, if anything, have you heard about the candidates running for president in 2020? (Name any candidates you have heard about and anything you've heard about them.)
Your answer
What issues would you like the presidential candidates to address?
Your answer
If you haven't voted or don't plan to vote, what are your reasons? (Listen to what the person says and check the box(es) that most closely capture(s) what the person says. Fill in their answer under other if it doesn't fit any of the choices given.) You may check more than one.
I'm not a citizen.
I don't have time/I'm too busy.
I don't have enough information.
I have to work.
It's too difficult.
I don't like the candidates, campaign, or issues.
I'm not interested.
I don't think my vote matters. My vote won't make a difference.
Other:
If you have voted or plan to vote, what are your reasons? (Listen to what the person says and check the box(es) that most closely capture(s) what the person says. Fill in their answer under other if it doesn't fit any of the choices given.) You may check more than one.
It's my right and responsibility.
I want my voice to be heard.
I am voting for or against a particular candidate.
People fought for the right to vote, so I should exercise my right.
Other:
What is the highest level of education you have completed?
Some high school
High school diploma or GED
Some college or associate's degree
Bachelor's degree
Graduate degree - MA, MPA, MBA, MD, JD, PhD
Clear selection
Gender
Male
Female
Prefer not to say
Other:
Clear selection
Marital Status
Married
Widowed
Divorced
Not Married
Other:
Clear selection
Age
under 18
18-24
25-34
35-44
45-54
55-64
65-74
75+
Clear selection
Job/Occupation
Your answer
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