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Please provide the following information:
First Name*:
Middle Initial:
Last Name*:
What grade are you in?*
Choose
6th
7th
8th
9th
10th
11th
12th
Ungraded
College/Technical School
Not Currently in School
What is your month and year of birth?*
Are you:*
Male
Female
Prefer not to answer
Are you Hispanic or Latino?*
Yes
No
What is your race?*
Mark one or more than one answer
American Indian or Alaskan Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Not Reported for Race
What is the zipcode of your home address?*
What is your Mother's first name?*
What Language is spoken at home? (optional)