Social Study #4457

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Social Study #4457

Email *

What is your first name? *

What is your last name? *

Please list what city that you live in: *

Please list the state that you live in: *

Please list the zip code that you live in: *

What is your phone number? *

What is your exact age? *

What is your DOB?

Example: 01/01/1996

What is your gender? *

Male

Female

Other:

Which of the following best describes your ethnicity? *

Asian

Black or African American

Pacific Islander or Native Hawaiian

Hispanic or Latino

Middle Eastern

Native American or Alaskan Native

White or Caucasian

Other:

Required

If you are selected to participate in this study, the session will be recorded for research purposes only. This information will not be shared publicly, and will solely be used for the purposes of this project.

Do you feel comfortable being recorded?
*

Yes

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