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* 1. What is your Name (First, Middle Initial and Last)?

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* 2. What is your Physical Address?

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* 3. What is your Email Address?

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* 4. Best phone to contact you? (Mobile or Home)

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* 5. How do you identify your race?

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* 6. Are you Hispanic or Latino?

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* 7. What is your age?

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* 8. What is your primary language spoken at home?

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* 9. What is your highest level of education completed?

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* 10. If you are currently in school, which one do you attend?

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* 11. What are the social media platforms you use frequently?

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