Gender:

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* 1. Gender:

Race/Ethnicity:

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* 2. Race/Ethnicity:

Age range:

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* 3. Age range:

Sexual orientation:

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* 4. Sexual orientation:

HIV status:

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* 5. HIV status:

Location:

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* 6. Location:

What is the highest grade or level of school that you have completed?

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* 7. What is the highest grade or level of school that you have completed?

Are you currently employed? (Please check all that apply)

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* 8. Are you currently employed? (Please check all that apply)

What is your estimated annual income?

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* 9. What is your estimated annual income?

What is your current housing situation?

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* 10. What is your current housing situation?

Do you currently have health insurance coverage?

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* 11. Do you currently have health insurance coverage?

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