A demographic survey questionnaire contains specific questions related to households, members in the family, any type of statistical characteristics of a city or state or country and other related areas. The results received through a demographic survey questionnaire are used for calculating census or in different sub areas of demographics including sociology, marketing, and public policy.

Sample Demographic Survey Questionnaire:

Name of the Participant: _____________________________

Date of Birth: ___________________ (MM/DD/YY) Gender: ___________ (M/F)

Address: ______________________________________  City:_______________

State: __________________  Zip: ________________

Email: _____________________________

Phone Number: ____________________________

  • Which age bracket do you fall in?

a)      Less than 25 years

b)      25-34 years

c)      35-44 years

d)     45-54 years

e)      55-64 years

f)       65-74 years

g)      75-84 years

h)      85-94 years

i)        95 +

  • Which of the following is your country of Origin?

a)      Afghanistan

b)      Bahrain

c)      Bangladesh

d)     Bhutan

e)      Brunei

f)       Cambodia

g)      China

h)      Cyprus

i)        Georgia

j)        India

k)      Indonesia

l)        Iran

m)    Iraq

n)      Israel

  • o)      Japan

p)      Jordan

q)      Korea (North/South)

r)       Kuwait

s)       Lebanon

t)       Malaysia

u)      Maldives

v)      Myanmar

w)    Nepal

x)      Oman

y)      Pakistan

z)      Others: ___________________________ (Please Specify)

  • Which of the following defines your marital Status?

a)      Married

b)      De Facto

c)      Divorced

d)     Widowed

e)      Separated

f)       Never Married

g)      Others: ___________________________ (Please Specify)

  • Which of the following languages do you speak most often?

a)      English (U.K)

b)      English (U.S)

c)      Hindi

d)     Bangla

e)      Nepalese

f)       Tibetan

g)      Vietnamese

h)      Japanese

i)        Cantonese

j)        Russian

k)      Others: ___________________________ (Please Specify)

  • Which is the highest education level completed by you?

a)      High School

b)      Bachelors

c)      Masters

d)     Doctorate

e)      Diploma

f)       Never went to school

g)      Never went to college

  • Who all are there in your household?

a)      Live alone

b)      With Spouse

c)      Spouse and children

d)     Brothers / Sisters / Both

e)      Parents and Spouse

f)       Parents and Siblings

g)      Others: ___________________________ (Please Specify)