Demographic questions 

OPO collects demographic information to identify disparities and ensure that our community outreach is equitable and inclusive. Your identity will remain anonymous.

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* What is your age in years? Please specify in number form. #:

Closed to responses

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* What zip code do you reside in?

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* What zip code do you work in?

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* Do you consider yourself to be a part of the LGBTQ community?

Yes
No
Prefer not to answer
Closed to responses

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* With which gender do you identify?

Woman
Man
Transgender Woman/ Trans Feminine
Transgender Man/ Trans Masculine
Non-Binary / Genderqueer / Gender Fluid
Two Spirit
Prefer to self-describe
Prefer not to answer
Closed to responses

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* Do you live with a physical or mental health condition? Or have you been diagnosed with a disability? (Examples: hearing loss, ADHD, depression, epilepsy, lupus)

Yes
No
Prefer not to answer
Closed to responses