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* 1. Age Group?

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* 2. Gender assigned at birth?

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* 3. Gender you currently identify with?

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* 4. Veteran's Status?

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* 5. What is your primary language?

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* 6. What is your sexual orientation?

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* 7. What is your race?

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* 8. What is your ethnicity?

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* 9. Please indicate which group you most identify with:

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* 10. Please indicate the area of the county in which you are most involved:

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* 11. Please indicate the population you feel is most unserved/underserved in the above-mentioned community:

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* 12. Do you have any comments or additional recommendations for the proposed Mental Health Services Act Annual Report FY 2020-2021 for Kern County?

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* 13. Please provide any suggestions for MHSA programs, services, or identified unserved/underserved populations:

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