Demographic Information

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* 1. In which Northwest Indiana County do you live?

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* 2. In what ZIP code is your home located? (enter 5-digit ZIP code; for example, 00544 or 94305)

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* 3. Are you a person living with a disability?

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* 4. Gender: How do you identify?

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* 5. Do you identify as LBGTQ+?

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* 6. What is your household monthly income?

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* 8. What is your race or ethnicity?

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