Survey Test

Census Questionaire

First Name *

Last Name *

Organization Name or N/A *

Email *

Web Site *

Residence Zip Code *

Workplace Zip Code *

What is your age? (For Statistical Purposes ONLY) *

What gender do you identify with? (Please select one – For Statistical Purposes ONLY) *

Female
Male
Non-binary/third gender
Prefer to self-describe
Prefer not to answer

What ethnicity do you identify as? (Select all that apply – For Statistical Purposes ONLY) *

Latinx/Hispanic
Caucasian
Native American
African American
Pacific Islander
Asian American
South Asian American
Mixed
Other

Primary Discipline/Medium: (choose ONE) *

Actor
Animation
Ceramics – Fine Art
Ceramics – Functional
Dance – Choreographer
Dance – Performer
Film/Videography
Glasswork – Fine Art
Glasswork – Functional
Graphic Design
Illustration – Commercial
Illustration – Fine Art
Instructor
Media Arts
Metalwork – Fine Art
Metalwork – Functional
Music – Production
Music – Songwriter
Music – Technical
Musician – Instrument
Musician – Singer
Painting
Photography – Commercial
Photography – Event
Photography – Fine Art
Photography – Portrait
Printmaking
Public Art – Murals
Public Art – Other Medium(s)
Public Art – Sculpture
Public Art – Temporary
Sculpture
Teaching Artist
Textile – Fashion
Textile – Fine Art
Theater – Director
Theater – Technical
Visual Art – Curating
Woodworking – Fine Art
Woodworking – Functional
Writing – Commercial/Copy
Writing – Creative
Writing – Journalism/Non-Fiction
Writing – Poetry
Other

Secondary Discipline/Medium: (choose ONE) *

Tertiary Discipline/Medium: (choose ONE) *

If you selected “Other” from the Discipline/Medium listings above, please enter your specific artistic discipline(s) in the field below.

On average, how many hours do you spend on your primary discipline per week? *

1 – 5 hours/week
5 – 15 hours/week
15 – 30 hours/week
30 – 40 hours/week
40+ hours/week

How many years have you been consistently working at your primary discipline? *

What is your household income? *

$0 – $30,000
$30,001 – $50,000
$50,001 – $80,000
$80,001 – $100,000
$100,001 – $150,000
$150,001 – $200,000
$200,001 – $500,000
$500,001+

By submitting this form, you consent to allow ACNV to use your aggregate information for statistical purposes only. Your name will not be used and your contact information will not be made public. Arts Council Napa Valley will contact you once, annually, to update or verify your statistical information. Thank you for participating in this important effort.

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