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Your Name:
Your Email Address:
Gender:
Male
Female Age:
18-25
26-35
36-50
51+
Ethnicity (check all that apply):
African-American
Asian
Hispanic
White
Other:
What is your
primary language?
English
Spanish
Chinese
Other:
What is your highest educational
level?
Grades 1-4
Grades 5-8
Some high school
High School Equivalency (GED)
High school graduate
Some college
College graduate or higher
Employment:
Currently employed
Seeking employment
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