The Pathways 2 Connect Home HIV Screening Project Question Title * 1. What type of device are you using to answer this survey? Cell Phone Tablet or IPAD Laptop Desktop Question Title * 2. Date of Birth: Question Title * 3. Address: Name Address Address 2 City/Town State/Province -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP/Postal Code Email Address Phone Number Question Title * 4. Ethnicity Hispanic/Latino Non Hispanic/Latino White or Caucasian Black or African American Hispanic or Latino Asian or Asian American American Indian or Alaska Native Native Hawaiian or other Pacific Islander Another race Declined to Answer Question Title * 5. Assigned Sex at Birth Male Female Question Title * 6. Current Gender Identity Male Female Transgender ( male to female) Transgender ( female to male) Non- Binary Another Gender Declined to Answer Question Title * 7. How would you like to receive your Free Home Testing Kit? Mail Non- Contact Pick Up by appointment Question Title * 8. How did you hear about this Project? Facebook AD Instagram A friend told me about it. I received an Email. Twitter Arkansas RAPPS website I'm not sure? I decline to say. Done