Instructions for Completing this Questionnaire

Purpose: This questionnaire aims to collect demographic data from participants to support our grant application process. Your responses will help us understand the diversity of our user base.
Confidentiality: All information you provide will be kept confidential and used only for the purposes stated in this questionnaire. Individual responses will not be shared and will be handled in compliance with data protection laws.
What We Want to Know:

Answer all questions to the best of your ability.
For questions with multiple-choice options, select the one that best describes you.

Time: The questionnaire should take less than 5 minutes.
Submission: After completing the questionnaire, click the "Submit" button at the end of the form.

If you have any questions or concerns, please do not hesitate to contact Dr. Leanne Furby at ileadtrustee@illinoisheartland.org.

Thank you for your participation and cooperation.