Self-Publisher Demographic Data

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This form is here to collect demographic information on self-publishers.

What is your race/ethnicity? *

White

Black

Hispanic

Asian

Indigenous (First Nations)

Multi-Racial

Other

What is your sex? *

Male

Female

Transgendered

What is your age? *

18 - 24 years old

25 - 30 years old

31 - 35 years old

36 - 39 years old

40 - 44 years old

45 - 54 years old

55 - 64 years old

65 - 74 years old

75 years or older

What is your sexual orientation?

Heterosexual

Homosexual

Bisexual

Clear selection

What is your marital status? *

Single, never married

Married

Divorced

Widowed

Separated

Live-in partner (not married)

Do you have children under 18 years old living in your home? *

Yes

Are you disabled?

Yes

Clear selection

Are you a military veteran?

Yes

Clear selection

Are you pregnant?

Yes

Clear selection

Where do you currently live?

Please state the country in which you presently reside.

What is your country of origin?

Please state which country you were born in.

Submit

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