What is your gender?

Select one

Female.

Male.

Other:

In what month and year were you born?


Month:	Year:
Month:	Year:

Month:

Year:

Month:

Year:

In which state do you live for most of the year?

Are you of Hispanic, Latino, or Spanish origin?

[Select one only]

No, not of Hispanic, Latino, or Spanish origin.

Yes.

What is your race?

[Select all that apply]

White (e.g. German, Irish, English, Italian, Lebanese, Egyptian, etc.).

Black or African American (e.g. African American, Jamaican, Haitian, Nigerian, Ethiopian, Somali, etc.).

American Indian or Alaska Native (e.g. Navajo Nation, Blackfeet Tribe, Mayan, Aztec, Native Village of Barrow Inupiat Traditional Government, Nome Eskimo Community, etc.).

Asian (Chinese, Filipino, Indian, Pakistani, Cambodian, Hmong, Vietnamese, Korean, Japanese, etc.).

Pacific Islander or Native Hawaiian (e.g. Native Hawaiian, Samoan, Chamorro, Tongan, Fijian, Marshallese, etc.).