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* 1. Does your household have: (Select All That Apply)

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* 2. Which Age Group Are You in?

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* 3. Marital Status

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* 4. What is Your Current Living Situation?

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* 5. What Do You Do For Work?

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* 6. What Does Your Spouse/Partner Do For Work? (If Applicable)

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* 7. What is Your Name?

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* 8. Address

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* 9. Phone Number (We do NOT share your information. We only contact you if you are selected)

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* 10. Spouse/Partner's Name (If Applicable)

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