Part I : Demographic data
1) Date of birth:
Year Month (select) January February March April May June July August September October November December
Day
2) Gender:
(select) Male Female
3) Highest level of education
completed (please specify):
Part II: Activities
The purpose of the segment of the survey is to establish which activities, in the fields of culture, leisure, sport, or other, are a routine part of the life of Corvinia's population.
For the purpose of this survey, "culture" includes sport, leisure, popular culture, and high culture.
4) Please specify which cultural activities you regularly engage in as an active participant (that is, not as a member of the audience - this might include painting, sports, singing, etc.):
5) Please specify which cultural activities you regularly engage in as an passive participant (that is, not as a performer - this might include listening to opera, reading, etc.):
Part III: Cultural Heritage nominations
The purpose of the segment of the survey is to allow you to nominate up to twenty-five (25) individual works of art, cultural activities, individual artists, or any other object, work or person that you feel should be permanently regarded as a part of Corvinia's cultural heritage.
Guidelines:
-You may nominate anything - if high diving or "Winnie the Pooh" is your idea of a good time, feel free to name them. Be as specific as you like, or as general.
- No duplicates are allowed.
- You need not fill up the list. If you feel that only ten objects belong on the list, feel free to stop after that.
- Do not nominate anything concerned with soccer (european rules football); this would constitute an endorsement of a criminal act, and would place you in violation of the law.
- There is no need to nominate the poet E. A. Poe, or any of his works - they are automatically part of the national heritage.
- The nominations need not be in any particular order, as each entry will receive one vote, regardless of position in the list.
6) Please register up to 25 nominations for the Corvinian cultural heritage:
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Sabotage prevention: To ensure that the person filling out this form is a citizen of Corvinia, and not a random passerby, we invite you to enter in this box some piece of information which would not be common knowledge to non-citizens (if you cannot think of any, enter your name and e-mail, so we may confirm your nominations with you).