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* 1. Contact Information:

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* 2. What is your age?

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* 3. What is your DOB?

Date

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* 4. What is your gender?

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* 5. Which of the following best describes your ethnicity?

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* 6. If you are selected to participate in this study, the session will be recorded for research purposes only. This information will not be shared publicly, and will solely be used for the purposes of this project.

Do you feel comfortable being recorded?  

T