STATUS OF WOMEN AND MEN IN PLANNING

Part 1 of 5

 

Section 1:  Demographics

If retired, please respond to questions based on your last employment.
  1. Gender:   female   male


  2. What is your age?   (use whole number)


  3. What is your current relationship status?
    married       separated      divorced      widowed    re-married
    never married     non married partnership (domestic)    common law


  4. What is your racial/ethnic background?
    Caucasian   African American   Hispanic
    Asian   Native American   Other, Specify


  5. Country of residency?
    a.

    b. country of citizenship, if different than residency?
       


  6. Number of children: (use digits)

    Ages of children:
    (Enter as whole numbers. For children under 1 year, enter as a decimal, ex. 3 months = .25)

    a. 1st child   b. 2nd child   c. 3rd child   d. 4th child
    e. 5th child   f. 6th child   g. 7th child   h. 8th child
    i. 9th child   j. 10th child        
    k. additional children, values separated by commas

  7. How many people live in your household? (use digits)


  8. Are you the primary caregiver for an elderly relative?
    a. yes     no

    b. Is the elderly relative a member of the household?
        yes      no


  9. What is your annual gross salary, including bonuses, (in USD) for 2005?
    a. less than $34,999   $35,000-$41,999   $42,000-$49,999
      $50,000-$59,999   $60,000-$69,999   $70,000-$79,999
      $80,000-$99,999   $100,000-$149,999   $150,000 and over

    b. What is the gender of the individual who primarily determines your salary?
        female  male


  10. Does your spouse/partner work outside the home?
        no     yes, full-time    yes, part-time    n/a


  11. What is the total annual gross household income (in USD) for 2005?
      less than $34,999   $35,000-$41,999   $42,000-$49,999
      $50,000-$59,999   $60,000-$69,999   $70,000-$79,999
      $80,000-$99,999   $100,000-$149,999   $150,000 and over

  12. Do you currently have employee benefits?
    a. yes    no

    b. If yes, please check all the types that apply:
      health insurance   retirement plan   sick days, paid
      life insurance   daycare   flextime
      mental health   dental insurance   paid vacation
      eye exams/ glasses   personal days    
      family medical leave   other, specify
      family friendly policies, specify

    c. What is the total annual gross amount of your share (in USD) to maintain these benefits?
        $   (use only digits, no commas)


  13. What is the gross amount your household paid out of pocket on health insurance and health and dental expenses (in USD) during 2005?
    $0-250   $251-500   $501-750
    $751-1000   $1001-1500   $1501-2000
    $2001-3000 $3001-4000   over $4001


  14. Are you presently a student in a higher education institution?
    a. yes    no

    If yes to 14a, then answer 14b
    b. full time    part time


  15. Since graduation from college or university, have you worked continuously?
      yes      no


  16. Since graduation, have you worked in the field of planning?
      yes     no


  17. Since graduation, have you worked in fields other than planning?
      yes     no


  18. I am satisfied with the balance between my work and other aspects of my life.
     strongly disagree 1    2    3    4    5   strongly agree

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