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Fall 2010 Community Dialogue on Gender Registration

17% of survey complete.

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* 1. All your answers will be anonymous. We would, however, like to be able to compare the same person’s answers to survey questions before and after participation in a Community Dialogue.

Please answer the following three questions so we can simultaneously “tag” your completed survey and keep your identity anonymous. For example, if the parent that you choose is named "Lisa" and your home town is "Chicago" and your birthday is on the 11th of April, then your tag name would become "LC11."

What is the first letter of a parent's name?

What is the first letter of your home town (city or town name)?

What is the numerical date of your birthday?

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* 2. FIRST NAME:

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* 3. LAST NAME

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* 4. CAMPUS MAILING ADDRESS

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* 5. MAILING ADDRESS

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* 6. CITY

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* 7. STATE

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* 8. ZIP CODE

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* 9. Seven digit Emory Employee ID (if you are a student and do not know your id, enter 0000000)

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* 10. EMORY E-MAIL ADDRESS (If you do not have an Emory email account, type "No Emory e-mail")

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* 11. ALTERNATE EMAIL ADDRESS

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* 12. PHONE