Identification Questions

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* 1. Full Name

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* 2. Ethnicity/Race (select all that apply)

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* 3. Email

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* 4. Phone Number

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* 5. Age Range

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* 6. What gender do you identify with?

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* 7. Do you have children under the age of 18? 

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* 8. Are you a resident of the City of South El Monte?

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* 9. If not, in what city do you live in?

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* 10. Do you work/go to school/other in the City of South El Monte? 

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* 11. If not, in what city do you work/go to school/other in?

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* 12. How do you commute daily to work/school/other?

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