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* 1. First Name:

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* 2. Last Name:

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* 3. What state do you currently reside?

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* 4. Phone Numbers:

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* 5. What is your exact age? (digits only)

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* 6. Are you currently enrolled at a college/university and what best describes the type you are currently attending?

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* 7. What year are you in college/university?

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* 8. What is your current living situation at school?

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* 9. In order to ensure we are including a variety of people, which of the following best describes your ethnic background?

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