VADIC Clearinghouse Services: Data Colletion

Please tell us more about yourself. This information will help us fulfill our federal grant requirements and allow us to continue to offer the services of our clearinghouse free to all who use it. Let us know who we are serving, or not serving, in our community. We consider this information private and it will only be reported as part of an aggregate data report. Thank you for your participation.

Are you:

Question Title

* 1. Are you:

What is your age?

Question Title

* 2. What is your age?

What race best describes you? (You may mark more than one.)

Question Title

* 3. What race best describes you? (You may mark more than one.)

Are you Hispanic / Latino?

Question Title

* 4. Are you Hispanic / Latino?

T