The Black Altar
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THESE DEMOGRAPHIC QUESTIONS HELP US BETTER UNDERSTAND OUR SERVICE COMMUNITY. There is an option to “Decline to state”.
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Please indicate the racial categories you most strongly identify with. You may use the open-ended box below to elaborate if you wish. (please select all that apply) (required): Asian / Asian American / Asian diasporicBlack / African American / Afro-Caribbean / African diasporicHispanic / Latina/o/x diasporicMiddle Eastern / Arabic / North African diasporicNative / Alaskan Native / IndigenousNative Hawaiian /Samoan / different Pacific IslanderWhite / EuropeanDecline to stateDifferent identity (please elaborate below)
If you selected “Different identity (please elaborate below)” above or wish to elaborate on your racial identity, please elaborate here:
Please indicate the gender(s) you most strongly identify with. You may use the open-ended box below to elaborate if you wish. (please select all that apply) (required): AgenderGender expansiveGender fluidGender non-conformingGenderqueerManNon-binaryTwo-spiritWomanDecline to stateDifferent gender (please elaborate below)
If you selected “Different gender (please elaborate below)” above or wish to elaborate on your gender identity, please elaborate here:
Do you identify as transgender? (required) NoYesDecline to state
Which of these languages, other than English, do you speak fluently as a primary or secondary language? (please select all that apply) (required): Afghan languages (Pashto, Dari, or another dialect)ArabicAmharicCambodian / KhmerCantoneseJapaneseKoreanLaotianMandarinOromoRussianSign Language (any type)SomaliSpanishTagalogTigrinyaThaiUkrainianVietnameseDecline to stateDifferent language (please elaborate below)
If you selected “Different language(please elaborate below)” above or wish to elaborate on the languages you speak, please elaborate here:
Do you experience living with a disability that impacts your daily life? (please select all that apply) (required): I do not live with a disabilityChronic conditionMobility/physical disabilityNeurodivergent (learning, intellectual, and cognitive)Mental health conditionDeaf or hard of hearingBlind or low-vision, or other vision disabilitiesDecline to stateDisability not listed (please elaborate below)
If you indicated living with a disability that impacts your daily life, how can we best meet your access needs?
What is your age? (please select one) (required): Under 1818 to 2425 to 2930 to 3940 to 4950 to 6465 and olderDecline to state
