Sample Demographic Questionnaire

A demographic questionnaire is intended to collect information about sex/gender, ethnicity, racial diversity and geographical or national focus. Since most such questionnaires are meant to gauge the diversity of a specific population area, the questions are formulated to be as inclusive as possible.  This also means that the questionnaires have fixed choices, which the respondents select. There is always an option of “Other” where the respondent is given a freehand at stating their answers. Most of such questionnaires are formulated with the knowledge that some of the questions may be too invading on the respondents’ privacy.  Below is a sample:

Please complete this form:

1.Gender: Male________ Female________ Transgender________

2.Date of Birth________

3.Current schooling level

Junior High School________   Senior High School________

Sophomore________   Freshman________

4.Do you have a girl friend/ boyfriend?

Yes________   No________

If your answer is YES in 4 above, answer 5 and 6 below:

5.I am : (check whichever is applicable)

?Dating different girls/boys

?Committed to one person who I am dating

?Dating one person, but am not committed to him/her.


6.I have been in the current relationship for:

?Less than six months

?Between six and 12 months

?Between one and three years

?More than three years

7.How many close friends of the opposite gender do you have?

?Just one


?More than five

8.How many close friends in the same gender to you have?



?More than three

9.Do you believe that such friendships affect your academic performance?

?Not when I balance the two well



Category: Business Questionnaire

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