PWNW ARTIST/STAFF Survey

PWNW ARTIST/STAFF Survey
Performance Works NW is collecting demographic information for our use only. This information is used to evaluate the reach and access of our programs for ourselves and for our funders. All internal evaluation and reports to funders will be done anonymously. We welcome your feedback as to the language used in this effort in the box at the bottom of this page.

If you are submitting this form as a part of an application, please note that the deadline for submitting this form is the same as the deadline for submitting your application.
Name

PrefixFirst NameMiddle NameLast NameSuffix
Email
example@example.com
Have you filled out our Demographic Survey before (choose one)?

YESNONOT SURE
I am filling this out today because my present engagement with PWNW is (select all that apply)

Alembic Residency ApplicantAlembic Parent Residency ApplicantAlembic Co-Production ArtistPWNW Public Access Artist (performance rental)Board memberPanel or Jury memberStaff memberIndependent ContractorVolunteer
Zipcode
Age

18 - 2930 - 4950 - 65>65prefer not to say
Household Income

< $25,000$25,000 - $49,999$50,000 - $99,999$100,000 - $199,999>$200,000Decline to state
How many people are supported by this household income?
Do you identify as LGBTQ2SIA+?

YESNODecline to state
How do you describe your gender identity?
Leave blank if you prefer not to answer
Gender Identity

Transgender womanTransgender manTransgender personGender non-conforming personGenderqueer personCis womanCis manDecline to state
My gender isn't listed above. I describe my gender identity as...
Do you currently live with disability?

YESNODecline to state
Ethnicity, Cultural Heritage, Language, Background (please check as many as apply or write in below):

African-AmericanAfricanHispanic/LatinxLatin AmericanMiddle EasternArab-AmericanEuropeanEuropean-AmericanAsian (SE, S. Pacific Islander)Asian-American (AAPI)Born outside of USParents born outside USDecline to stateIndigenous to the Americas
Ethnicity, Cultural Heritage, Language: please self-describe
Leave blank if you prefer not to answer.
Not listed (please specify), clarification.
Please share any feedback you have about the language on this form.
Should be Empty: