* 1. Gender:

* 2. Race/Ethnicity:

* 3. Age range:

* 4. Sexual orientation:

* 5. HIV status:

6. Location:

* 7. What is the highest grade or level of school that you have completed?

* 8. Are you currently employed? (Please check all that apply)

* 9. What is your estimated annual income?

* 10. What is your current housing situation?

* 11. Do you currently have health insurance coverage?

T