1.

Please read and answer each question carefully. For each answer, mark an X in the appropriate box. If you want to change an answer, erase your first answer completely and mark the X of your new answer. You may decline to answer specific questions.

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* 1. How old are you?

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* 2. What is your zip code?

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* 3. Please describe your race/ethnicity.

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* 4. What is your U.S. Citizenship Status?

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* 5. If you did migrate, how long have you been in the U.S.?

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* 6. If applicable, what country/countries did you or your families migrate from?

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* 7. What is your gender identity?

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* 8. For each of the following documents, please check whether of not you have been able (allowed) to change the documents or records or records to reflect your current gender.

  Yes, changes allowed No, changes denied My legal status does not allow me Not tried N/A
Birth Certificate
Drivers License and/or state issues non-driver ID
Social security records
Passport
Work ID
Military discharge papers (DD 214 or DD 215)
Health Insurance Records
Student Records
Professional licenses or credentials

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* 9. What is your sexual orientation?

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* 10. Are you HIV positive?

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* 11. If you are HIV positive, are you currently receiving treatment?

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* 12. If you are receiving treatment, is it covered by your insurance? 

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* 13. If you don’t have insurance, how are you obtaining HIV treatment/prescriptions?

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* 14. In general, are you currently aware of what protections you are granted under the law?

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* 15. In which of the following areas do you feel you face the most discrimination as a transgender person?

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* 16. What is the highest level of education you have completed (either in the U.S. or country of origin)?

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* 17. If you have not received a formal education or completed a degree program, what is the reason?

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