*1.Contact Info(Required.)

Name

Phone

E-Mail

Age

City

State

*2.Please indicate your current gender identity below.(Required.)

Male

Female

I identify otherwise

*3.What was your sex assigned at birth?(Required.)

Male

Female

*4.How do you identify?(Required.)

Asian / Asian American

Black /Afro-Caribbean / African American

East Asian

Filipino

Pacific Islander

Native American or Alaskan Native

Hispanic American / Latinx

Middle Eastern

South Asian / Indian/ Indian American

White / Caucasian American

Other (please specify)

*5.Which of the following ranges best describes your total annual household income before taxes last year (2025)?(Required.)

Under $25,000

25,000 - $34,999

$35,000 - $49,999

$50,000 - $74,999

$75,000 - $99,999

$100,000 - $149,999

$150,000 - $199,999

$200,000 or More