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* 1. Please enter your zip code here:

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* 2. We’re interested in learning how student opinions and experiences may vary from those of older adults. Are you currently a student?

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* 3. How important an issue do you think racism/prejudice is in America?

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* 4. How important an issue is racism/prejudice for Duxbury?

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* 5. How strongly do you agree or disagree with this statement: “If we work on this together, in the next few years, we can make Duxbury a prejudice-free community.”

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* 6. There are various forms of prejudice and we would like you to consider how concerned you are about each type

  Very concerned Somewhat concerned Not very concerned Not concerned at all
Ageism (based on age)
Classism (based on socio-economic class)
Disability prejudice
Ethnic prejudice (based on a group sharing a common and distinctive culture, religion, language, or the like)
Homophobia (including bias against all LGBTQ groups)
Racism
Religious prejudice (e.g. antisemitism, Islamophobia)
Sexism
Sizism (including all forms of physical prejudice)

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* 7. What initiatives do you think are important to pursue in making Duxbury a prejudice free community? (rank 1-7, with 1 as top priority)

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* 8. Have you or a member of your family experienced any form of prejudice or discrimination in the past five years?

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* 9. If so, which of these did you experience? (check all that apply)

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* 10. Would you be willing to document your experience as part of creating a total picture of prejudice in Duxbury?

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* 11. If yes, check all that apply:

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* 12. Would you be willing to volunteer your time to help make Duxbury a prejudice free community?

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* 13. If you answered “yes to question 10 or “definitely” or “maybe” to question 12, please share your name and email address with us here:

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* 14. Answer optional: Do you or a member of your family identify with any of the following groups or basis for prejudice? Check all that apply:

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* 15. Please add any comments or suggestions here:

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* 16. Would you like to be on our mailing list for news and updates? If yes, please add your name and email address here (if not added earlier)

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