Spanish Language Community Review Committee Survey

1.First Name(Required.)

2.Last Name(Required.)

3.Primary Email Address(Required.)

4.What is your connection to cystic fibrosis?(Required.)

I have cystic fibrosis

I have a child who has cystic fibrosis

I am married to someone who has cystic fibrosis

I have a sibling who has cystic fibrosis

Other (please specify)

5.Are you of Hispanic, Latino, or Spanish origin?
Please select all that apply.(Required.)

No, not of Hispanic, Latino, or Spanish origin

Yes, Mexican, Mexican American, Chicano

Yes, Puerto Rican

Yes, Cuban

Yes, another Hispanic, Latino, or Spanish origin (for example, Argentinean, Colombian, Dominican, Nicaraguan, Salvadoran, Spaniard, etc.)

Spanish Language Community Review Committee