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Note: * represents a required field. FIRST 200 SUBMISSIONS WILL RECEIVE A $5.00 REIMBURSEMENT AT THE EMPOWERMENT CONFERENCE REGISTRATION TABLE.

SECTION 1: GENERAL INFORMATION

* What is your email address?
* Are you an active member of the IPYPU?	Member	Supporter	Neither
* Do you attend IPYPU events?	Yes	No
* Do you have a desire to attend IPYPU events?	Yes	No
* What is your age?	0 - 15	16 - 20	21 - 25	26 - 30	31 +
* What is your gender?	Male	Female
* Which state were your born in?
* Which state do you currently live in?
* What is your marital Status?	Single	Engaged	Married	Divorced	Widowed
How many children do you have or care for?	0	1	2	3	4 +
In what type of home do you live?	Own	Rent	N/A

SECTION 2: EDUCATION	STRONGLY AGREE	AGREE	NEUTRAL	DISAGREE	STRONGLY DISAGREE

I have graduate from high school.
I have my GED.
I attend/attended a public school.
I attend/attended a private school.
I attend/attended a magnet school.
I attend/attended a charter school.
My high school councelor told me the options for continuing education.
A college recruiter told me the options for continuing education.
I have enrolled/completed an online course.
I am considering going back to school.
I am a full-time college student.
I am a part-time college student.
If you are in college, what is your anticipated major?
I have graduated from college.
I have family member who have graduated from college.
I have completed a graduate program.
I need/needed financial aid for college.
I have loans to pay for college.
I have received scholarship/grant funds to pay for college.
My employer pays some of my college expenses.
I have/will benefit from a college degree?
I have considered attending trade school.
If you have considered trade school, what trade?
I have considered the military as an alternative to college.
I know the options and benefit of military education.

SECTION 3: CELLULAR PHONES	STRONGLY AGREE	AGREE	NEUTRAL	DISAGREE	STRONGLY DISAGREE

I have a cellular phone.
If you have a cellular phone, who is your carrier?	T-Mobile	Verizon	U.S. Cellular	Sprint	AT&T
If you have a cellular phone, who is your carrier?	Nextel	Alltel	Prepaid	Other
I am satisfied with my cell phone carrier.
I am interested in learning about alternative cell phone carriers.
I have internet service on my cell phone.
I check my email on my cell phone.
I have a camera on my cell phone.
I have an MP3 player on my cell phone.
I have a touch screen cell phone.
I have a hard cell phone case.
I have a soft cell phone case.
I have a house phone.
I use my cell phone as a house phone.
I can text from my cell phone.
I text on my cell phone more than I make calls.
I have a lot of minutes in my phone plan.
300-600 minutes is a lot of minutes.
600-900 minutes is a lot of minutes.
900 or more minutes is a lot of minutes.
I go over my allotted minutes often.
In order to not go over my minutes, I need an unlimited minutes plan.
My "free night" minutes begin by 7:00 p.m. on Friday evening.
My "free night" minutes begin by 9:00 p.m. on Friday evening.
If another carrier offered earlier "free night" minutes, I would consider switching.
My cell phone drops call more often than my friend's phones.
My cell phone service area is smaller than my friend's areas.
I pay my own cell phone bill.
I pay a lot for my cell phone service.
Paying $50 or less is to much for a cell phone plan.
Paying $100 or less is to much for a cell phone plan.
Paying $100 or more is to much for a cell phone plan.
Paying $100 or less is to much for a Blackberry plan.
Paying $100 or more is to much for a Blackberry plan.

SECTION 4: FAST FOOD	STRONGLY AGREE	AGREE	NEUTRAL	DISAGREE	STRONGLY DISAGREE

What's your favorite fast food restaurant?
I like the following restaurant most.	McDonald	Burger King	Wendy's	Yum Brands	Chipotle
	Hardee's	Jack in the Box	Arby's	Chick-fil-A	Boston Market
	Subway	Quiznos	Dominos	Papa John's	Panda Express
I like the following soft drink most.	Coke Classic	Diet Coke	Caffeine-free Diet Coke	Pepsi	Diet Pepsi
I like the following soft drink most.	Mountain Dew	Diet Mountain Dew	Dr. Pepper	Sprite	Fanta
I like restaurant with a lot of variety.
I visit fast food restaurants for breakfast.
I visit fast food restaurants for lunch.
I visit fast food restaurants for dinner.
I enjoy having a value menu available.
I can purchase a satisfying meal for $5 or less.
I can eat healthy at fast food restaurants.
I can get a good variety of desserts at a fast food restaurant.
I look for coupons when I buy fast food.
I have worked at a fast food restaurant.
There is a fast food restaurant in my neighborhood, within a 6 mile radius.

SECTION 5: APPEARAL	STRONGLY AGREE	AGREE	NEUTRAL	DISAGREE	STRONGLY DISAGREE

I wear trendy attire to school.
I wear a uniform to school.
I wear business formal attire to work.
I wear business casual attire to work.
I wear a uniform to work.
I like to buy clothes.
I spend more than $500 on clothes every month.
I spend more than $1,000 on clothes every month.
I spend more than $1,500 on clothes every month.
I like to shop at the mall.
I like boutique shops more than the mall.
I feel good when I buy something new.
I prefer fitted or tight jeans.
I prefer loose-fitted or baggy jeans.
I buy clothes I like, regardless of current fashion.
I buy new fashion looks only when they are well accepted.
I am not as concerned about fashion as I am about modest prices and wearability.
In this period of rising prices, spending excessive amounts of money on clothes is ridiculous.
My top three shopping locations are:	1. 2. 3.
My top three clothing brands are:	1. 2. 3.
My top three shoe brands are:	1. 2. 3.

SECTION 6: MISCELLANEOUS	STRONGLY AGREE	AGREE	NEUTRAL	DISAGREE	STRONGLY DISAGREE

I own a computer.
I have access to a computer.
I am on Facebook.
I am on MySpace.
I like to blog and read blogs.
I like to Twitter.
I have cable TV.
I have satellite TV.
I watch TV less than 2 hours a day.
I watch TV less than 5 hours a day.
I watch TV more than 5 hours a day.
I have an email account.
I vote!
I rent movies weekly.
I rent movies monthly.
I buy movies weekly.
I buy movies monthly.

SECTION 7: HEALTH CARE	STRONGLY AGREE	AGREE	NEUTRAL	DISAGREE	STRONGLY DISAGREE

I have a major health condition.
I know what blood pressure is.
I know what a healthy blood pressure is.
I know what cholesterol is.
I know what a healthy cholesterol level is.
I have an annual physical.
I get my teeth cleaned every 6 months.
I use the following tooth paste:
I use mouth wash everyday.
I floss everyday.
I drink 8 glasses of water everyday.
I am a healthy person.
Heart disease runs in my family.
Cancer runs in my family.
I have a regular physician.
I have a regular dentist.
I have health insurance.
I am covered under someone elses health insurance.
I have been without health insurance.
Thank you for taking time to complete this survey. Your input will assist the IPYPU in acquiring corporate sponsorship and expanding the programs that we make available to you everytime we come together to fellowship. Please, send this survey link to your friends and ask them to complete the survey as well; more input => more opportunity

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