LGBT Media Survey Questions + Sample Questionnaire Template

The Lesbian, Gay, Bisexual, & Transgender (LGBT) media survey template consists of questions for evaluating and understanding the reach of media and its use by the LGBT community. This sample questionnaire template was created by industry experts to bring you insightful responses about how the community attitude in general towards the LGBT community be improved. It consists of multiple survey questions that collect demographics information and in-depth information about the perception of the LGBT community and their if the use of media can alter that perception.

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What is your gender?

Male

Female

Transgender (Male -> Female)

Transgender (Female -> Male)

Other

What is your sexual orientation?

Heterosexual

Bisexual

Homosexual

Transsexual

Who are you out to?

Friends

Family

Coworkers

None of the above

Not applicable/No response

What is your age?

Under 17

18 – 20

21 – 24

25 – 29

30 – 39

40 – 49

50 – 59

60 and over

What is your partnership status?

Single

Dating

Domestic/Life Partner

Civil Union

Married

Divorced/Separated

Widowed

What is your highest level of education?

No Schooling Completed

Less than High School

High School

Some College

Associate Degree (ex: AA, AS)

Bachelor’s Degree (BA, AB, BS)

Master’s Degree (ex: MA. MS, MEng, MEd, MSW, MBA)

Professional Degree (ex: MD, DDS, DVM, LLB, JD)

Doctorate Degree (ex: PhD, EdD)

What is your race? (Please check all that apply.)

Native Hawaiian
Chinese
White
Guamanian or Chamorro
Asian India
Mexican, Mexican American, Chicano
Black or African American
Japanese
Puerto Rican
Korean
Vietnamese
Samoan
American Indian or Alaska Native
Filipino
Cuban
Other

What is your current employment status?
Part-time student
Full-time student
Work part-time
Work full-time
Unemployed

What industry are you employed in?

How many hours a week of television do you watch?
0 – 2 hours
3 – 4 hours
5 – 7 hours
8 or more hours

Where do you live?

What is your annual household income?
Under $25,000
$25,000 – $34,999
$35,000 – $49,999
$50,000 – $64,999
$65,000 – $79,999
$80,000 – $99,999
$100,000 – $149,999
$150,000 or more
Prefer not to answer

For each of the choices below, please indicate the extent of your media usage.
Never
Rarely
Occasionally
Frequently
Very Frequently
Newspapers
Never
Rarely Occasionally Frequently Very Frequently
Magazines
Never
Rarely Occasionally Frequently Very Frequently
Internet
Never
Rarely Occasionally Frequently Very Frequently
Television
Never
Rarely Occasionally Frequently Very Frequently
Radio
Never
Rarely Occasionally Frequently Very Frequently
Theatre
Never
Rarely Occasionally Frequently Very Frequently
Film/Cinema (Outside the home)
Never
Rarely Occasionally Frequently Very Frequently

For each of the choices below, please indicate the extent of your television viewing.
Never Watch
Rarely Watch
Watch Occasionally
Watch Frequently
Watch Very Frequently
Cable Networks (Including ABC, NBC, FOX, etc.)
Never Watch
Rarely Watch Watch Occasionally Watch Frequently Watch Very Frequently
Cable News Networks (Including CNN, MSNBC, etc.)
Never Watch
Rarely Watch Watch Occasionally Watch Frequently Watch Very Frequently
Public Television (Including National, Regional, or Local)
Never Watch
Rarely Watch Watch Occasionally Watch Frequently Watch Very Frequently
Premium Cable Networks (Including HBO, Showtime, Cinemax, etc.)
Never Watch
Rarely Watch Watch Occasionally Watch Frequently Watch Very Frequently
Music Television Networks (Including MTV, VH1, CMT, etc.)
Never Watch
Rarely Watch Watch Occasionally Watch Frequently Watch Very Frequently
International/World Networks (Including BBC, etc.)
Never Watch
Rarely Watch Watch Occasionally Watch Frequently Watch Very Frequently
LGBT Networks (Including Logo, Here!, QTV, etc.)
Never Watch
Rarely Watch Watch Occasionally Watch Frequently Watch Very Frequently

For each of the television networks listed below, please indicate your exposure and viewing frequency.
Never Heard of
Never Watch
Rarely Watch
Watch Occasionally
Watch Frequently
Watch Very Frequently
Logo
Never Heard of
Never Watch Rarely Watch Watch Occasionally Watch Frequently Watch Very Frequently
Here! TV
Never Heard of
Never Watch Rarely Watch Watch Occasionally Watch Frequently Watch Very Frequently
Q Television Network
Never Heard of
Never Watch Rarely Watch Watch Occasionally Watch Frequently Watch Very Frequently

For each of the programs listed below, please indicate your exposure and viewing frequency.
Never Heard of
Never Watch
Rarely Watch
Watch Occasionally
Watch Frequently
Watch Very Frequently
In the Life
Never Heard of
Never Watch Rarely Watch Watch Occasionally Watch Frequently Watch Very Frequently
Will & Grace
Never Heard of
Never Watch Rarely Watch Watch Occasionally Watch Frequently Watch Very Frequently
The Ellen Degeneres Show
Never Heard of
Never Watch Rarely Watch Watch Occasionally Watch Frequently Watch Very Frequently
The L Word
Never Heard of
Never Watch Rarely Watch Watch Occasionally Watch Frequently Watch Very Frequently
Queer as Folk
Never Heard of
Never Watch Rarely Watch Watch Occasionally Watch Frequently Watch Very Frequently
Round Trip Ticket
Never Heard of
Never Watch Rarely Watch Watch Occasionally Watch Frequently Watch Very Frequently
Wisecrack
Never Heard of
Never Watch Rarely Watch Watch Occasionally Watch Frequently Watch Very Frequently
Graham Norton
Never Heard of
Never Watch Rarely Watch Watch Occasionally Watch Frequently Watch Very Frequently
Noah’s Ark
Never Heard of
Never Watch Rarely Watch Watch Occasionally Watch Frequently Watch Very Frequently
Open Bar
Never Heard of
Never Watch Rarely Watch Watch Occasionally Watch Frequently Watch Very Frequently
Never Heard of
Never Watch
Rarely Watch
Watch Occasionally
Watch Frequently
Watch Very Frequently
It’s All Relative
Never Heard of
Never Watch Rarely Watch Watch Occasionally Watch Frequently Watch Very Frequently
Queer Eye for the Straight Guy
Never Heard of
Never Watch Rarely Watch Watch Occasionally Watch Frequently Watch Very Frequently
Queer Eye for the Straight Girl
Never Heard of
Never Watch Rarely Watch Watch Occasionally Watch Frequently Watch Very Frequently
Sex and the City
Never Heard of
Never Watch Rarely Watch Watch Occasionally Watch Frequently Watch Very Frequently
The Suze Orman Show
Never Heard of
Never Watch Rarely Watch Watch Occasionally Watch Frequently Watch Very Frequently
60 Minutes
Never Heard of
Never Watch Rarely Watch Watch Occasionally Watch Frequently Watch Very Frequently
Huff
Never Heard of
Never Watch Rarely Watch Watch Occasionally Watch Frequently Watch Very Frequently
Extreme Makeover: Home Edition
Never Heard of
Never Watch Rarely Watch Watch Occasionally Watch Frequently Watch Very Frequently
Desperate Housewives
Never Heard of
Never Watch Rarely Watch Watch Occasionally Watch Frequently Watch Very Frequently
Law & Order
Never Heard of
Never Watch Rarely Watch Watch Occasionally Watch Frequently Watch Very Frequently
Never Heard of
Never Watch
Rarely Watch
Watch Occasionally
Watch Frequently
Watch Very Frequently
Project Runway
Never Heard of
Never Watch Rarely Watch Watch Occasionally Watch Frequently Watch Very Frequently
America's Next Top Model
Never Heard of
Never Watch Rarely Watch Watch Occasionally Watch Frequently Watch Very Frequently
Survivor
Never Heard of
Never Watch Rarely Watch Watch Occasionally Watch Frequently Watch Very Frequently
The Apprentice
Never Heard of
Never Watch Rarely Watch Watch Occasionally Watch Frequently Watch Very Frequently

For each of the magazines and periodicals listed below, please indicate your exposure and viewing frequency of both print and online editions.
Never heard of
Never Read
Rarely Read
Read Occasionally
Read Frequently
I’m a Subscriber
Local / Regional LGBT Newspapers and/or Magazines
Never heard of
Never Read Rarely Read Read Occasionally Read Frequently I’m a Subscriber
Local / Regional Mainstream Newspaper and/or Magazines
Never heard of
Never Read Rarely Read Read Occasionally Read Frequently I’m a Subscriber
The New York Times
Never heard of
Never Read Rarely Read Read Occasionally Read Frequently I’m a Subscriber
The Wall Street Journal
Never heard of
Never Read Rarely Read Read Occasionally Read Frequently I’m a Subscriber
Genre
Never heard of
Never Read Rarely Read Read Occasionally Read Frequently I’m a Subscriber
The Advocate
Never heard of
Never Read Rarely Read Read Occasionally Read Frequently I’m a Subscriber
Out
Never heard of
Never Read Rarely Read Read Occasionally Read Frequently I’m a Subscriber
Details
Never heard of
Never Read Rarely Read Read Occasionally Read Frequently I’m a Subscriber
GQ
Never heard of
Never Read Rarely Read Read Occasionally Read Frequently I’m a Subscriber
Cargo
Never heard of
Never Read Rarely Read Read Occasionally Read Frequently I’m a Subscriber
Never heard of
Never Read
Rarely Read
Read Occasionally
Read Frequently
I’m a Subscriber
Men's Health
Never heard of
Never Read Rarely Read Read Occasionally Read Frequently I’m a Subscriber
Esquire
Never heard of
Never Read Rarely Read Read Occasionally Read Frequently I’m a Subscriber
Domino
Never heard of
Never Read Rarely Read Read Occasionally Read Frequently I’m a Subscriber
Time
Never heard of
Never Read Rarely Read Read Occasionally Read Frequently I’m a Subscriber
Newsweek
Never heard of
Never Read Rarely Read Read Occasionally Read Frequently I’m a Subscriber
People
Never heard of
Never Read Rarely Read Read Occasionally Read Frequently I’m a Subscriber
US Weekly
Never heard of
Never Read Rarely Read Read Occasionally Read Frequently I’m a Subscriber
Real Simple
Never heard of
Never Read Rarely Read Read Occasionally Read Frequently I’m a Subscriber
InStyle
Never heard of
Never Read Rarely Read Read Occasionally Read Frequently I’m a Subscriber
Vogue
Never heard of
Never Read Rarely Read Read Occasionally Read Frequently I’m a Subscriber
Never heard of
Never Read
Rarely Read
Read Occasionally
Read Frequently
I’m a Subscriber
Vanity Fair
Never heard of
Never Read Rarely Read Read Occasionally Read Frequently I’m a Subscriber
W
Never heard of
Never Read Rarely Read Read Occasionally Read Frequently I’m a Subscriber
Curve
Never heard of
Never Read Rarely Read Read Occasionally Read Frequently I’m a Subscriber
Instinct
Never heard of
Never Read Rarely Read Read Occasionally Read Frequently I’m a Subscriber
Out Traveler
Never heard of
Never Read Rarely Read Read Occasionally Read Frequently I’m a Subscriber
Architectural Digest
Never heard of
Never Read Rarely Read Read Occasionally Read Frequently I’m a Subscriber
Passport
Never heard of
Never Read Rarely Read Read Occasionally Read Frequently I’m a Subscriber
Pride
Never heard of
Never Read Rarely Read Read Occasionally Read Frequently I’m a Subscriber
Girlfriends
Never heard of
Never Read Rarely Read Read Occasionally Read Frequently I’m a Subscriber
Scene
Never heard of
Never Read Rarely Read Read Occasionally Read Frequently I’m a Subscriber
Never heard of
Never Read
Rarely Read
Read Occasionally
Read Frequently
I’m a Subscriber
Gay & Lesbian Review Worldwide
Never heard of
Never Read Rarely Read Read Occasionally Read Frequently I’m a Subscriber

For each of the statements below, please indicate the extent of your agreement or disagreement.
Strongly disagree
Disagree
Neutral
Agree
Strongly agree
I prefer companies who advertise to LGBT consumers in LGBT media.
Strongly disagree
Disagree Neutral Agree Strongly agree
I would like to see more companies advertise to LGBT consumers in mainstream media.
Strongly disagree
Disagree Neutral Agree Strongly agree
I actively seek out companies who advertise directly to LGBT consumers when making purchasing decisions.
Strongly disagree
Disagree Neutral Agree Strongly agree
I actively seek out companies who support the LGBT community when deciding what products and/or services to buy.
Strongly disagree
Disagree Neutral Agree Strongly agree
Given the choice between two comparable products (same features & price) from a brand that advertises to LGBT consumers, and a brand that does not advertise to LGBT consumers, I would purchase from the brand that advertises to LGBT consumers.
Strongly disagree
Disagree Neutral Agree Strongly agree
I prefer LGBT media to mainstream media.
Strongly disagree
Disagree Neutral Agree Strongly agree
I prefer to read newspapers that print same-sex announcements.
Strongly disagree
Disagree Neutral Agree Strongly agree
I support civil unions and/or domestic partnerships.
Strongly disagree
Disagree Neutral Agree Strongly agree
I support extending marriage to same-sex couples.
Strongly disagree
Disagree Neutral Agree Strongly agree
I prefer online news media to print news media.
Strongly disagree
Disagree Neutral Agree Strongly agree

For each of the statements below, please indicate the level of importance to you.

Unimportant
Of little Importance
Moderately Important
Important
Very Important
Strengthening hate crime legislation and including provisions for LGBT individuals.
Unimportant
Of little Importance Moderately Important Important Very Important
Corporate nondiscrimination policies that include gender (or perceived gender) and protection for LGBT individuals.
Unimportant
Of little Importance Moderately Important Important Very Important
Extending the protections and benefits of marriage to same-sex couples.
Unimportant
Of little Importance Moderately Important Important Very Important
Providing safe school environments across the country so that LGBT students are protected from discrimination and violence.
Unimportant
Of little Importance Moderately Important Important Very Important
Increasing LGBT characters in television programming.
Unimportant
Of little Importance Moderately Important Important Very Important
Increasing the reporting of LGBT newsworthy events on primetime news programs.
Unimportant
Of little Importance Moderately Important Important Very Important
Increasing diversity programs and awareness in schools.
Unimportant
Of little Importance Moderately Important Important Very Important

For each of the genres below, please indicate your interest and likelihood of viewing the following types of programming.
Never
Probably Not
Possibly
Probably
Definitely
Travel
Never
Probably Not Possibly Probably Definitely
Music
Never
Probably Not Possibly Probably Definitely
Comedy
Never
Probably Not Possibly Probably Definitely
Movies
Never
Probably Not Possibly Probably Definitely
Drama
Never
Probably Not Possibly Probably Definitely
Sitcom
Never
Probably Not Possibly Probably Definitely
News
Never
Probably Not Possibly Probably Definitely
Documentary
Never
Probably Not Possibly Probably Definitely
Sports
Never
Probably Not Possibly Probably Definitely
Finance
Never
Probably Not Possibly Probably Definitely
Never
Probably Not
Possibly
Probably
Definitely
Talk Shows
Never
Probably Not Possibly Probably Definitely
Home Decorating / Interior Design
Never
Probably Not Possibly Probably Definitely
Game Shows
Never
Probably Not Possibly Probably Definitely
Reality Shows
Never
Probably Not Possibly Probably Definitely
Celebrity-based Shows
Never
Probably Not Possibly Probably Definitely
Political Discussion / Debate
Never
Probably Not Possibly Probably Definitely
Health & Wellness
Never
Probably Not Possibly Probably Definitely
Animals & Wildlife
Never
Probably Not Possibly Probably Definitely
History
Never
Probably Not Possibly Probably Definitely
International Programming
Never
Probably Not Possibly Probably Definitely

Please indicate your interaction with the following brands over the past 12 months.
Never heard and never purchase
Heard but never purchased
Heard of and also purchased
Eastman Kodak
Never heard and never purchase
Heard but never purchased Heard of and also purchased
Continental Airlines
Never heard and never purchase
Heard but never purchased Heard of and also purchased
United Airlines
Never heard and never purchase
Heard but never purchased Heard of and also purchased
Ameriprise Financial
Never heard and never purchase
Heard but never purchased Heard of and also purchased
eBay
Never heard and never purchase
Heard but never purchased Heard of and also purchased
Dell Computer
Never heard and never purchase
Heard but never purchased Heard of and also purchased
Apple Computer
Never heard and never purchase
Heard but never purchased Heard of and also purchased
Bacardi
Never heard and never purchase
Heard but never purchased Heard of and also purchased
Motorola
Never heard and never purchase
Heard but never purchased Heard of and also purchased
General Motors (Including Pontiac & Saab)
Never heard and never purchase
Heard but never purchased Heard of and also purchased
Never heard and never purchase
Heard but never purchased
Heard of and also purchased
Subaru
Never heard and never purchase
Heard but never purchased Heard of and also purchased
American Express
Never heard and never purchase
Heard but never purchased Heard of and also purchased
E*Trade
Never heard and never purchase
Heard but never purchased Heard of and also purchased
Earthlink
Never heard and never purchase
Heard but never purchased Heard of and also purchased
Glaxo SmithKline
Never heard and never purchase
Heard but never purchased Heard of and also purchased
Johnson & Johnson
Never heard and never purchase
Heard but never purchased Heard of and also purchased
Hewlett Packard
Never heard and never purchase
Heard but never purchased Heard of and also purchased
Travelocity
Never heard and never purchase
Heard but never purchased Heard of and also purchased
Miller Brewing
Never heard and never purchase
Heard but never purchased Heard of and also purchased
Anheuser-Busch
Never heard and never purchase
Heard but never purchased Heard of and also purchased
Never heard and never purchase
Heard but never purchased
Heard of and also purchased
The New York Times
Never heard and never purchase
Heard but never purchased Heard of and also purchased
Lions Gate Films
Never heard and never purchase
Heard but never purchased Heard of and also purchased
Tower Records
Never heard and never purchase
Heard but never purchased Heard of and also purchased
1-800-Mattress
Never heard and never purchase
Heard but never purchased Heard of and also purchased
Sleepy’s
Never heard and never purchase
Heard but never purchased Heard of and also purchased
Sharper Image
Never heard and never purchase
Heard but never purchased Heard of and also purchased
Orbitz
Never heard and never purchase
Heard but never purchased Heard of and also purchased
Toyota
Never heard and never purchase
Heard but never purchased Heard of and also purchased
ABC Carpet & Home
Never heard and never purchase
Heard but never purchased Heard of and also purchased
1-800-PetMeds
Never heard and never purchase
Heard but never purchased Heard of and also purchased
Never heard and never purchase
Heard but never purchased
Heard of and also purchased
Avis
Never heard and never purchase
Heard but never purchased Heard of and also purchased
Allstate
Never heard and never purchase
Heard but never purchased Heard of and also purchased
Procter & Gamble
Never heard and never purchase
Heard but never purchased Heard of and also purchased
Kraft Foods
Never heard and never purchase
Heard but never purchased Heard of and also purchased
Hyundai
Never heard and never purchase
Heard but never purchased Heard of and also purchased
Amstel Light
Never heard and never purchase
Heard but never purchased Heard of and also purchased
Kenneth Cole
Never heard and never purchase
Heard but never purchased Heard of and also purchased
Ikea
Never heard and never purchase
Heard but never purchased Heard of and also purchased
T-Mobile
Never heard and never purchase
Heard but never purchased Heard of and also purchased
John Hancock Financial Services
Never heard and never purchase
Heard but never purchased Heard of and also purchased
Never heard and never purchase
Heard but never purchased
Heard of and also purchased
Mercedes-Benz
Never heard and never purchase
Heard but never purchased Heard of and also purchased
California Closets
Never heard and never purchase
Heard but never purchased Heard of and also purchased
IBM
Never heard and never purchase
Heard but never purchased Heard of and also purchased
Hyatt Resorts
Never heard and never purchase
Heard but never purchased Heard of and also purchased
Jaguar
Never heard and never purchase
Heard but never purchased Heard of and also purchased
Land Rover / Range Rover
Never heard and never purchase
Heard but never purchased Heard of and also purchased
Volvo
Never heard and never purchase
Heard but never purchased Heard of and also purchased
JPMorgan / Chase
Never heard and never purchase
Heard but never purchased Heard of and also purchased
Bridgestone Tires
Never heard and never purchase
Heard but never purchased Heard of and also purchased
Audi
Never heard and never purchase
Heard but never purchased Heard of and also purchased
Never heard and never purchase
Heard but never purchased
Heard of and also purchased
Absolut
Never heard and never purchase
Heard but never purchased Heard of and also purchased

Do you agree with the following?
Yes
Maybe
No
Will LGBT television networks (like LOGO) improve attitudes toward the LGBT community?
Yes
Maybe No
Will ads on LGBT television networks improve attitudes toward the LGBT community?
Yes
Maybe No
Will LGBT television networks provide a broader portrayal of LGBT characters?
Yes
Maybe No

Are you interested in participating in future research studies?
No Thanks
Yes, My email address is:

use this free template

LGBT Media Survey Questions + Sample Questionnaire Template

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