ADR DEMOGRAPHIC INFORMATION The provision of Court ADR services is made possible through major support from the Los Angeles County Department of Community and Senior Services through the California Dispute Resolution Program Act. As part of the funding requirements, the collection of demographic information is required. All information is confidential. Participant Description Gender Age Individual – Representing Self Male 17 or < Individual With Attorney Female 18-39 Individual Representing Business Other 40-59 Individual Representing Govt Entity 60+ Total Insurance Company Representative Declined to State Attorney Representing Client Total Other Total County Supervisorial District – Residence or Business/Govt/Firm/Organization Site (1) First/Gloria Molina Second/Mark Ridley-Thomas Third/Zev Yaroslavsky Fourth/Don Knabe Fifth/Mike Antonovich Outside Los Angeles County Total Asian – Chinese Primary Language Spoken at Home Asian – Filipino English Asian – Korean Spanish South – Asian Other Other Asian Declined to State Black-African American Total Latino-Central American Self-Identified Economic Status/Lifestyle Latino-Mexican American Low Income Latino-Other Middle Income Middle Eastern or Arab Upper Middle Income White – Caucasian High Income Other Declined to State Declined to State Total Total If Individual/Atty Representing Business - Size Small Medium Large/Big LAADR 011 (Rev. 08/09) LASC Approved 11-03 American LegalNet, Inc. www.FormsWorkFlow.com