NOP Census HomeNOP Census Application Complete count of Nepalese Origin People (NOP) residing in the State of Georgia Application Project Status: DRAFT MODEProject End Date: December 31, 2023 Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form. - Step 1 of 2Today's date *1. Are you of age 18 years and older?a. Yesb. No2. Where do you currently reside? Please provide your street name, city and zip code.2a. Street name ONLY (ex. Bradford Square)2b. City2b. City (Atlanta)2c. Zipcode2c. Zipcode (30093)3. Last 4 digits of your phone number.4. What is your gender?a. Maleb. Female5. Number of MALE adults in household - How many members of your household, including yourself, are 18 years of age or older? Selected Value: 0 6. Four level adult age – Is the MALE adult (if there are more than one male adult in your household, please select the age group of each male adult, check all that apply):a. 18 years to less than 29 years of ageb. 30 years to less than 44 years of agec. 45 years to less than 59 years of aged. 60 years and older7. Number of FEMALE adults in household - How many members of your household, including yourself, are 18 years of age or older? Selected Value: 0 8. Four level adult age – Is the FEMALE adult (if there are more than one female adult in your household, please select the age group of each female adult, check all that apply):a. 18 years to less than 29 years of ageb. 30 years to less than 44 years of agec. 45 years to less than 59 years of aged. 60 years and older9. Marital status – Are you ….?a. Marriedb. Divorcedc. Widowedd. Separatede. Never marriedf. Living with partner10. What is the highest grade or year of school you completed?a. Less than high schoolb. High schoolc. Some college or technical schoold. Bachelor’s degree or higher11. Do you own or rent your home?a. Ownb. Rentc. Other arrangement12. Employment status - Are you currently …?a. Working - as a paid employeeb. Working - self-employedc. Out of work (temporary layoff from a job, looking for work)d. A homemakere. A studentf. Retiredg. Unable to work due to disability13. Number of MALE children in household – How many children less than 18 years of age live in your household? Selected Value: 0 14. Four level child age – Is your MALE child (if there are more than one male children in your household, please select the age group of each male child, check all that apply):a. 0 months to less than 5 years of ageb. 5 years to less than 10 years of agec. 10 years to less than 15 years of aged. 15 years to less than 18 years of age15. Number of GIRL children in household – How many children less than 18 years of age live in your household? Selected Value: 0 16. Four level child age – Is your FEMALE child (if there are more than one female children in your household, please select the age group of each FEMALE child, check all that apply):a. 0 months to less than 5 years of ageb. 5 years to less than 10 years of agec. 10 years to less than 15 years of aged. 15 years to less than 18 years of age17. Income level – Is your annual household income from all sources:a. Less than $15,000b. $15,000 to less than $25,000c. $25,000 to less than $35,000d. $35,000 to less than $50,000e. $50,000 to less than $75,000f. $75,000 to less than $100,000g. $100,000 or more18. Do you currently have any kind of health insurance?a. Yesb. No19. Are you a US Citizen?YesNoOtherYou must be 18 years of age to complete the NOP census application. Please do not submit this application, close or exit the browser. NextUpdating preview…This is a preview of your submission. It has not been submitted yet! Please take a moment to verify your information. You can also go back to make changes.PreviousSubmit
