¿Qué Pasa, Midwest? Identity Survey

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Si es usted un Latino living in the Midwest, háganos saber lo que quiere saber, and we'll cover it. ¿Qué Pasa, Midwest? is a bilingual reporting network sharing historias de latinos viviendo en el Medio Oeste también compartiendo información y noticias relevante para la comunidad. In an effort to track community voices, esperamos que complete esta encuesta. It should take menos de cinco minutos y su participación is greatly appreciated and helpful in ensuring diverse voices and perspectives are heard in the Midwestern Latino community. Gracias por ayudarnos a determinar what topics and issues ¿QPM? should explore!

First Name/Nombre & Last Name/Apellido *

Please put "Anon" for last name if you would like to protect your identity. Por favor conteste "Anon" para el apellido si desea proteger su identidad.

Email/Correo electronico *

If you don't have an email address, please put NA. Si no tiene un correo electronico, conteste NA.

Hometown and state /Pueblo natal y estado *

City that you consider home. Ciudad que considere su pueblo natal. Example/Ejemplo: Chicago, IL

Country of origin/País de origen

Please list all that apply. Por favor anote todos los que aplican.

What is your preferred language?/¿Cuál es su idioma preferido?

English/Ingles

Spanish/Español

Spanglish

It depends on the situation/Depende de la situacion

Other:

Race & Ethnicity / Raza & Etnicidad *

Select any that apply. Por favor selecione todos los que aplican.

Latino(a)(x)/Hispanic/Chicano(a)

Black or African-American/Negro(a) o Africano(a)-Americano(a)

Indigenous American/Indígeno(a) Americano(a)

White/Blanco(a)

Asian/Asiático(a)

Native Hawaiian/other Pacific Islander/Hawaiano(a) nativo(a)/otro(a) Isleño(a) del Pacífico(a)

Middle Eastern or Arab-American/Medio Oriente o Arabe-Americano(a)

Prefer not to share race or ethnicity/Prefiero no compartir raza o etnicidad

Not sure/No estoy seguro

Other:

Required

Age Range/Rango de edad *

10-25

26-41

42-57

58-76

77-94

Older than 94/Más de 94

Gender/Sexo *

Female/Mujer

Male/Hombre

Transgender Female/Mujer transgénero

Transgender Male/Hombre transgénero

Genderqueer or Gender non-conforming/Género no conforme

Prefer not to share gender/Prefiero no compartir el género

Not sure/ No estoy seguro

Other:

Sexual orientation/Orientación sexual

Select any that apply. Por favor selecione todos los que aplican.

Lesbian/Lesbiana

Gay

Bisexual

Queer

Straight/Heterosexual

Prefer not to share sexual orientation/Prefiero no compartir orientacion sexual

Not sure of sexual orientation/No estoy seguro

Other:

Political Ideology/Ideología política

Very Liberal/Muy liberal

Liberal

Moderate or neutral/Medio o neutral

Conservative/Conservativo

Very Conservative/Muy Conservativo

Prefer not to share/Prefiero no compartir

Not sure of political ideology/No estoy seguro

It depends on the topic/Depende del tema

Other:

Clear selection

Is there anything else you wish to share about yourself or your community?/¿Hay algo más que quisiera compartir sobre usted o su comunidad?

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