GENERAL INFORMATION

In order to protect your identity we have created a Unique Identifier System instead of asking your name. 
 

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1. What is your date of birth (Example 17th)

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2. What are the LAST two digits of your Social Security Number?  (If none, answer 99)

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3. What is your Middle Initial?  (If none, answer "Z")

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4. What are the last two digits of the year you were born? ( ex:  You would enter 80 if you were born in 1980)

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5. What is your zip code?

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6. Do you consider yourself:

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7. Do you consider yourself:

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8. What is your ethnicity?

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