Qualified Micronationalist Survey

(Nota Bene: Surveyor follows XIV Commandments for Right to Privacy purposes)

Pre-nominal letters:

Full Name:

Age:

Alternative nationalist since year:

Gender of Nationalist:

Male
Female

Relationship status of Nationalist:

Single
In a relationship
Married
Widowed
Separated
Divorced

Number of male natural/adopted children:
Number of female natural/adopted children:

Education of Nationalist:

Primary school diploma
Secondary school diploma
Associate's or Foundation degree (some college)
Bachelor's or Diplomate's degree
Master's or Professional's degree
Doctorate's or Scholar's degree

Languages spoken fluently (check one or more, or write in):

Italian
French
Portuguese
Russian
German
Spanish
Arabic
Japanese
Swedish
Dutch
Other:
Other:
Other:

Citizen type:

Normal citizen
Diplomat or Representative
Minister or Bureaucrat
Head or Leader

Email of Nationalist (please ensure it is correct):

Name of Nation:

Conscious adult population (non-theoretical):

3-24 citizens
25-50 citizens
51-100 citizens
101-200 citizens
201-300 citizens
301-500 citizens
501-750 citizens
751-1000 citizens
1001-1500 citizens
More than 1500 citizens

National classification:

Very young nation/micronation (few members)
More clan/business than parish/nation
More parish/nation than village/state
More village/state than town/county
More town/country than city/region

Nation's website or wiki article:

National membership or recognition (check one or more, or write in):

Grand Unified Micronational
Antarctic Micronational Union
League of Secessionist States
MicroState
Organisation de la MicroFrancophonie
Unrepresented United Nations
SIL International
Nations Without States
Organization of Emerging African States
Confederation of Independent Football Associations
Paradiplomatic Affairs
Norwegian Nobel Committee
Office of United Nations and Other International Organizations (PH)
IP Australia
General Administration of Press and Publication (China)
Foreign and Commonwealth Office (UK)
United States Patent and Trademark Office
Other:
Other:
Other:

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Additional comments (if any):