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Blood Donation Survey
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What is your gender?
Male
Female
Clear selection
In what year were you born?
Your answer
How often do you use the Internet?
Once or more a day
A few times per week
A few times per month
Hardly ever
Never
Clear selection
What is the highest level of education you completed?
Primary school
Some secondary school, but did not finish
Completed secondary school
Some university but did not finish
Four-year university degree (B.A., B.S.)
Some graduate work
Completed masters or professional degree
Advanced graduate work or Ph.D.
Clear selection
Not counting religious organizations, how many civic or community organizations do you belong to?
(e.g. Kiwanis Club, PTS, League of Women Voters)
Your answer
How would you describe your current employment status?
Employed full time
Employed part time
Unemployed / Looking for work
Student
Homemaker
Retired
Clear selection
Have you ever donated blood?
Yes
No
Clear selection
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