Intake Demographics Name(Required) First Last Email(Required) Pronouns(Required) she/hers he/him they/them ze/hir ze/zir xe/xem prefer not to say other Pronouns: other(Required)Hearing Status(Required) Deaf DeafDisabled DeafBlind Hard of Hearing Late Deafened Hearing prefer not to say other Hearing Status: other(Required)Ethnicity/Race(Required)Select all that applies. African-American / Black Asian American Hispanic / Latinx/o/a Middle Eastern Native American / Indigenous Pacific Islander White / Caucasian prefer not to say other Ethnicity/Race: Other(Required)Age(Required) Under 16 16 - 25 26-35 36-45 46-55 56-65 66+ prefer not to say Education(Required) Some high school High School Diploma Some college Associate's Degree Bachelor's Degree Master's Degree Professional Degree Doctorate Degree prefer not to say other Education: other(Required)Economic Status(Required) Under $25k $25k - $49k $50k - $100k $100k - $200k Over $200k prefer not to say Δ
