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Optional Info: Tell us a little bit about yourself
Fill out the fields below to help tailor our screenings.
Ethnicity origin (or Race): Please specify your ethnicity.
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Education: What is the highest degree or level of school you have completed?
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Household Income: What is your total household income?
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$10,000 to $39,999
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$70,000 to $99,999
$100,000 to $149,999
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Children: How many children do you have?
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