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* 1. Please specify your ethnicity/race

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* 2. Would you like to be entered into our prize drawings? (You must complete the entire survey to qualify for (1) entry into the drawing. Additional entries: you can qualify for (1) additional entry by follow @ownyourstorynewark on either Instagram or Facebook to qualify for (1) entry, uploading a 3 minute video sharing your personal story at the end of this survey. You can also qualify for (1) additional entry for each social media platform that you share the Own Your Story Newark Survey link - simply tag @ownyourstorynewark or screenshot each post and email ownyourstory@tandemed.com)

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* 3. Please provide us with some additional information before we get started

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