Name of Program: Date of Program

DEMOGRAPHIC SURVEY

In order to receive government and foundation support, it is necessary for Kentucky Shakespeare to keep an accurate record of our audience demographic statistics. All responses will be treated with the strictest confidence.

Please complete this Demographic Survey and return it to the Artist Educator at the end of the program.

Kentucky Shakespeare does not discriminate in any of its programming or hiring practices on the basis of race, color, religion, national origin, age, sex, or disability.

Teacher Name:

School:

Name of Program: Date of Program:

[Please Note Actual Numbers, Not Percents]

Total Student Attendance: ______Male: Female:

Caucasian American: African American:

Asian American: Hispanic American:

Native American: Multi Racial:

Other (please specify): ______

Students with disabilities (please specify):

** THANK YOU FOR YOUR ASSISTANCE** Kentucky Shakespeare 323 West Broadway, Ste. 401 Louisville, KY 40202 (502) 574-9900 (502) 566-9200 Fax Website: www.kyshakespeare.com