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Unit 2 Sample Survey Form
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Individual Data
What is your age in years?
Your answer
How long does it take you to travel to work in minutes?
None if unemployed
Your answer
How many people share a car to work or school?
1 means you drove alone, None means not employed
Your answer
Average number of hours worked per week in the past year
Your answer
What was your total income in dollars this past year?
Your answer
Household Data
What is your household's annual water cost in dollars?
Your answer
What is your household's yearly cost of fire, hazard, and/or, flood insurance in dollars?
Your answer
What is your household's gross rent (including cost of utilities) divided by your total household income?
Your answer
How many people under the age of 18 live in your household?
Your answer
How many total people live in your household? (Including children)
Your answer
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