We want to know what YOU think.

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We want to really understand what young people want and need to be engaged, empowered, and happy in their communities. We want to know what will help you stay in or move to a rural Kansas community. By answering the following questions, you'll help us move forward by ensuring a great representative mix of Kansans. Thank you! Marci Penner of the Kansas Sampler Foundation will be doing the interviews.

Name

Address

City (where you live now) and zip code

County

Hometown

Cell phone

Race (select all that apply)

White

Black or African American

Asian

Native Hawaiian and other Pacific Islander

Other

Clear selection

Other, optional to specify

Hispanic or Latino:

Yes

Clear selection

Gender

Female

Male

Other

Clear selection

Sexual orientation

Heterosexual or straight

Homosexual

Bisexual

Transgender

Other

Prefer not to answer

Clear selection

Age

Education attainment

High School

Some College

Community College graduate

Tech School graduate

Four year college graduate

College Masters

College Doctorate

Other

Clear selection

Job/means of income (share as much as you'd like)

Hobbies/Volunteer groups

Clear form

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