View source for Debt Relief: Survey SAMPLE

Debt Relief Survey
Professional Communication
ENGL 3106

*We are conducting this survey to gather information about the financial debt problems of the average student. The data that we receive will be processed and our findings will be posted on a website that is being constructed to help students manage their debt. We do not want or need any information other than what is being asked for.
Thank you for your time. 


1.  How old are you?
	(circle one)
	18-21		22-25		26-30		30+


2.  Sex:	M		F


3.  What is your ethnic background?
	African-American		American Indian		Asian-American
	
	Caucasian		Hispanic-American		Other


3.  Do you have any credit cards in your name?
	Yes		No
	If yes, how many?  __________	


4.  Approximately how much total debt has been accumulated on those cards?  
	(circle one)
	$0-500		$500-1000	   $1000-1500		$1500-2000	       $2000+


5.  Do you have a car payment?
	Yes		No	    
	If yes, approximately how much is it per month? __________


6.  How much do you spend on miscellaneous or non-essential expenditures per week?
	$0 – 30	$30 – 70	$70 – 120	$120+
	




7.  Do you rent an apartment or pay a mortgage on a house?
	Yes		No
	If yes, approximately how much is it per month? __________


8.  Do you have any dependents?
	Yes		No	   If yes, then how many?  ______



9.  Are you currently employed?
	Yes		No	
	If yes, what is your approximate hourly wage?
	(circle one)
	Minimum wage-$7	     $7-10	$10-15		$15+


10.  Do you currently have any school loans?	
	Yes		No



11.  Do you currently receive either the HOPE or the Pell Grant?
	Yes		No


12.  Do you plan to attend any post-graduate schooling 
	(e.g. law school, medical school, technical school)?
	Yes		No



13.  Approximately how much debt do you anticipate having by the end of your 	education?
			___________________________



14.  Do you currently have or have recently had any major medical expenses?
	Yes		No



15.  Have you received any credit/debt management counseling or aid in the past?
	Yes		No


16.  If you knew about a website that gave practical information and options to help you 	manage your debt would you visit it?
	Yes		No