A demographic data questionnaire is used by government to establish specifics about the population. Most of the most common demographic categories in such questionnaires include ethnic origin, race, age and sex. The data generated from such surveys is then used for planning purposes. Common categories in the demographics data include population, where age, sex, race, marital status and education level is considered. Households are also a common category where the total households are considered for purposes of getting the average household size in a specific community. In the income category things such as household income, net worth, per-capita income and disposable income are considered.

Below is a sample.


Street address_______________________




Marital status: Married____ Single_____ Divorced_______ Separated_______

Q1. What is your education level?

High school diploma

Bachelor’s degree

Master’s degree


Q2. What is your average annual household income?

Below $50,000

Between $50,000 and $100,000

Between $100,001 and $200,000

Above $200,000

Q3. How many people live in your house?

Just me

Between 1 and 3

Between 4 and 6

More than six

Q4. Of people living in your household, how many are dependent on you?

(Please specify)_______________

Q5. What is your combined household income $_________

Q6. What is the amount of disposable income available in your household? $________

Q7. How would you rate the net worth of your household? $_____

Q8. What is the per capita income in your household? $_______

Q9. What is the median home value of your current residential house? $_______

Q10. Your current residential house is:



Not purchased but does not pay rent either

Under mortgage