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Ada Survey Essay

454 words - 2 pages

Survey Questions
1. What is your gender?
a. Male
b. Female

2. Please select your age category:
c. 0-18
d. 19-39
e. 40-49
f. 50-59
g. 60+

3. What is your race/ethnicity?
h. White
i. Hispanic or Latino
j. Black or African American
k. Native American or American Indian
l. Asian / Pacific Islander
m. Other

4. What is your knowledge about Diabetes?
n. I am very knowledgeable
o. I am somewhat knowledgeable
p. I have heard of the disease
q. I know nothing
5. What is your knowledge about The American Diabetes Association (ADA)? Please select all that apply
r. I do not know anything
s. I have heard of the ADA
t. I have been to their website
...view middle of the document...

I am personally not affected by Diabetes

7. If you have been diagnosed with Diabetes, what type do you have?
~. Type I
. Type II
. Gestational Diabetes
. N/A
8. How would you categorize your involvement within the community?
. Very involved
. Somewhat involved
. Rarely involved
. Never involved

9. Have you ever participated in a fundraising/awareness event for a medical cause?
. Yes
. No

10. If yes, what was your main reason for participating in those events? (Choose which reason most accurately describes you)
. I have/had the medical condition
. I have a direct family member who is/was affected by the medical condition
. I know a friend who has been affected by the medical condition
. I participated with a group of friends
. Participated on behalf of another organization I was involved in
. Motivation is not directly associated with medical condition

11. What type of event would you be most inclined to participate in?
. Physical Event (ex. Sporting event)
. Non-Physical Event (ex. Banquet)
. I would not attend one of these events

12. Which type of physical event would you be most likely to attend?
. Walk/Run
. Bike
. Triathlon
. Dance Marathon
. Not interested in a physical event
. Other participative sports (ex Basketball, soccer, jump rope, etc.) ________________________________

13. Which type of non-physical event would you attend?
. Banquet
. Silent Auction
. Retail Event (ex. x amount of the proceeds go towards the cause)
. Not interested in a non physical event
. Other

14. If you would be willing to be contacted for additional questioning, please provide this information.
Phone: _____________________________
Email: ______________________________

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