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Race, Poverty, & Progress: Documentary
Potential Participant Questionnaire
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Email
*
Your email
Why are you interested in being a part of this project? (choose one)
*
I want to help people
I serve as an advocate
I am concerned about the Black Community
I want my story to be heard
I work with diverse populations
I want a better future for the youth
Other:
First Name
*
Your answer
Last Name
*
Your answer
Address Number & Street
*
Your answer
City
*
Your answer
State
*
Your answer
Zip Code
*
Your answer
Phone Number
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Your answer
Age
18-30
30-40
40-50
50-60
60+
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Gender
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