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Event Booth | Calm Presentation Survey
Demographics
*
1.
What is your name?
(Required.)
*
2.
What is your email address?
(Required.)
*
3.
I am a:
(Required.)
Non-Profit Organization
School Principal
Assistant Principal
Other Leadership Role (Leadership Team)
Teacher
District Personnel
School Community Instructional Specialist (CIS)
School Counselor
Business Owner
Community Representative
Parent
Other (please specify)
*
4.
What is the name of the school/business/organization you represent?
(Required.)
*
5.
School/Business zip code:
(Required.)
6.
Best phone number to reach you at?
7.
Race
American Indian/Alaska Native
Asian
Black/African American
White
Pacific Islander
Multi-racial
Other
8.
Ethnicity:
Haitian
Hispanic
Non-hispanic