Demographic Information For Myself

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Gender*

Male

Female

Marital Status

Are you of Hispanic or Haitian origin?*

Yes

No

I prefer not to say

Is the address inside city limits?*

Yes

No

I'm not sure

Highest Level of Education

Did you serve in the Armed Forces?*

Yes

No

Do you have a copy of your DD-214 Form?

Yes

No

Not applicable

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