Impact100 DC Member Demographic Survey

Impact100 DC was created with an express goal of building an inclusive and diverse community across the many demographic divides in the Washington DC area. In order to achieve this goal, we need to assess where we are. To that end, we hope all members will complete the form below.

We will never share this information. We are gathering this information only to learn more about our members & to measure our progress in building a diverse organization.

Thank you in advance for your assistance!

Contact Information

Name

First Name

Last Name

Verify Email

Personal Demographics

Where in the DMV do you live?

Maryland

Virginia

Live outside the DMV

Where in DC do you live? (ward or neighborhood)

Where in Maryland do you live?

Montgomery County

Prince George's County

Where in Virginia do you live?

Arlington County

Fairfax County

City of Alexandria

City of Fairfax

City of Falls Church

Where do you live?

Race/Ethnicity

Check all that apply.

American Indian or Alaskan Native

Asian

Black or African American

Native Hawaiian / Pacific Islander

White

Other

Prefer not to say

Do you identify as LGBTQ+?

Yes

Prefer not to say

Age

Select the range that applies

21-30

31-40

41-50

51-60

61-70

70+

Prefer not to say

We'd love to know your birthday!

Please put the month and day (ex: 04-22 for April 22)

Household Income

Annual household income

Less than $50,000

$50,000 - $100,000

$100,000 - $150,000

$150,000 - $200,000

$200,000+

Prefer not to say

Field of Work

Note: This can be paid or unpaid work. If not currently working, please indicate your former and/or desired field of work. We are looking to learn our members' areas of interest and expertise.

Employment

Employed Full-Time

Employed Part-Time

Self-Employed

Seeking Opportunities

Full-time Parent/Caregiver

Leave/Sabbatical/Other time off

Retired

Prefer not to say