Demography questionnaire template


Please take a few minutes of your time to fill in the following survey.

1. In which of the following states do you live?

  • Alabama
  • Alaska
  • Arizona
  • Arkansas
  • California
  • Colorado
  • Connecticut
  • Delaware
  • Florida
  • Georgia
  • Hawaii
  • Idaho
  • Illinois
  • Indiana
  • Iowa
  • Kansas
  • Kentucky
  • Louisiana
  • Maine
  • Maryland
  • Massachusetts
  • Michigan
  • Minnesota
  • Mississippi
  • Missouri
  • Montana
  • Nebraska
  • Nevada
  • New Hampshire
  • New Jersey
  • New Mexico
  • New York
  • North Carolina
  • North Dakota
  • Ohio
  • Oklahoma
  • Oregon
  • Pennsylvania
  • Rhode Island
  • South Carolina
  • South Dakota
  • Tennessee
  • Texas
  • Utah
  • Vermont
  • Virginia
  • Washington
  • West Virginia
  • Wisconsin
  • Wyoming

2. Please write your postal or zip code:


3. Please confirm your gender:

  • Male
  • Female

4. To which of the following age ranges do you belong?

  • Under 17
  • 17 - 20
  • 21 - 30
  • 31 - 40
  • 41 - 50
  • 51 - 60
  • Over 60

5. What is your highest achieved level of education?

  • Incomplete elementary school
  • Elementary school
  • High school / incomplete
  • High school / completed
  • Higher vocational or technical college education
  • University bachelors degree
  • University Masters degree
  • University specialist degree (Doctoral, Legal)

6. Do you live with an entrepreneur or small business owner?

  • Yes
  • No

7. Which of the following best describes your current employment status?

  • Unemployed., Looking for work
  • Unemployed, Not looking for work
  • Employed at or close to the minimum wage
  • Employed part-time
  • Employed full-time
  • Retired
  • Disabled, Unable to work

8. What was your total income in 2016? (without deductions)

Include the net income from labour , business , pensions , dividends , interest , benefits, social benefits , unemployment benefits , and any other form of income .

9. What was the combined income of your household in 2011? (Without deductions)

Include the net income from labour , business , pensions , dividends , interest , benefits, social benefits , unemployment benefits , and any other form of income, also the income of those in your household aged 18 or above.


10. What is your current accommodation status?

  • Subletting
  • Renting
  • Living with parents
  • Living with an elderly relative
  • House or appartment owned by the family
  • Homeless
  • Currently at the liberty of HM Prision service

11. What is your marital status?

  • Married
  • Single
  • Surviving partner (Widower/Widow)

12. How many children under the age of 18 currently live in your household? (including yourself)


Use template — it’s free

Demographic survey USA

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Are you writing a final thesis and need to conduct a demographic survey? Use this questionnaire template to collect data that you can easily evaluate in Survio.

Use template — it’s free

The survey sample is ideal for

  • companies,
  • students,
  • researchers.

What is the highest level of education attained, marital status or approximate annual income of a representative sample? To what extent does the level of unemployment differ in individual localities? What prevails? Living in family houses or flats? With this questionnaire template you will get basic demographic data of respondents, which you will use in professional studies, university theses and other research. Companies can use this data to compile profiles of potential employees for selection procedures.

The questionnaire template can be fully edited. Survio will process your answers into well-arranged tables and graphs.

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