Tell Us About Yourself!

Form Jackson Tell Us About Yourself

Tell Us About Yourself

The following is a short demographic questionnaire used to help ensure our engagement process is representative of the City of Jackson. Your answers are anonymous.

What is your age?

<15 years

15-24 years

25-34 years

35-44 years

45-54 years

55-64 years

65 or older

What is your race?

Asian

Black/African American

Native American

White

More than one race

OtherOther

Where do you live? Choose a council ward using the map above for reference.

Ward 1

Ward 2

Ward 3

Ward 4

Ward 5

Ward 6

I live outside the city.

How did you hear about this?

City Notification

City Website

Word of Mouth

City's Facebook

OtherOther

Were you satisfied with this engagement opportunity?

Yes

Somewhat

No

OtherOther

Provide your email to stay up-to-date. (Note your email will only be used for official city notifications))

Submit

If you are human, leave this field blank.

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