Cohabitation/Marriage Survey for school - please fill out

If you are either married or cohabitating, please fill out this survey
for a paper in my sociology class. Thanks!

Name:
Gender of Respondent:
Age of Respondent:
Race or Ethnicity of Respondent:
Is the couple Married or Cohabitating?
Does the Woman work outside the home? Is it fulltime or part-time?

Does the Man work outside the home? Is it fulltime or part-time?

For the following topics, choose the best answer (Male, Female, Both
equally, Does not apply)

Cooking
Laundry
Mow Lawn
Clean Toilet
Vacuum
Wash Dishes
Fix broken
Items
Take our trash
Helps children w/ homework
Comforts
Child when sad or sick
Takes care of child