2021 BTS Questionnaire

First Name *

Last Name *

Birthday (mm/dd/yyyy) *

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Gender *

• Male
• Female

Email *

Phone *

Address (Line 1) *

Address (Line 2)

City *

State *

Zip Code *

Ministry Interest *

• Juvenile Justice
• Campus Life
• City Life KIX
• Catalyst Hip-Hop
• General

Staff Relationship *

What is your marital status? * Select one below Single (never married) Married, or in a domestic partnership Widowed Divorced Separated

What is the highest degree or level of school you have completed? *

If you’re currently enrolled in school, please indicate the highest degree you have received.

Select one below Less than a high school diploma High school degree or equivalent (e.g. GED) Some college, no degree Associate degree (e.g. AA, AS) Bachelor’s degree (e.g. BA, BS) Master’s degree (e.g. MA, MS, MEd) Professional degree (e.g. MD, DDS, DVM) Doctorate (e.g. PhD, EdD)

Household income level? * Select one below Less than $20,000 $20,000 to $34,999 $35,000 to $49,999 $50,000 to $74,999 $75,000 to $99,999 Over $100,000

What is your employment status? * Select one below Employed full time (40 or more hours per week) Employed part time (up to 39 hours per week) Unemployed and currently looking for work Unemployed and not currently looking for work Student Retired Homemaker Self-employed Unable to work