1. What is your gender?
2. Please select your age category:
3. What is your race/ethnicity?
i. Hispanic or Latino
j. Black or African American
k. Native American or American Indian
l. Asian / Pacific Islander
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
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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
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?
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?
. 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?
. Silent Auction
. Retail Event (ex. x amount of the proceeds go towards the cause)
. Not interested in a non physical event
14. If you would be willing to be contacted for additional questioning, please provide this information.