Big Inquiry Form
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Contact Information
First Name
Nombre
Last Name
Apellido
Mobile Phone
Número del celular
Email
Correo electrónico
For our information
Date of Birth
Fecha de nacimiento
Gender
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Female
Male
Trans Female
Trans Male
Genderqueer/Nonbinary
Different Identity
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Género
How do you identify?
¿Cómo se identifica usted de género?
Pronouns
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He, Him
She, Her
They, Them
Other pronouns
What pronouns do you use?
Race/Ethnicity
American Indian or Alaska Native
Asian - Chinese
Asian - Filipino
Asian - Indian
Asian - Japanese
Asian - Korean
Asian - Other
Asian - Vietnamese
Black or African American
Hispanic - Cuban
Hispanic - Mexican,Mexican American,Chicano
Hispanic - Other Latinx or Spanish origin
Hispanic - Puerto Rican
Middle Eastern or North African
Other
Pacific Islander - Chamorro
Pacific Islander - Native Hawaiian
Pacific Islander - Other
Pacific Islander - Samoan
White or Caucasian
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Zip Code
Código postal
County
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Bay
Escambia
Okaloosa
Santa Rosa
Walton
Condado
Agency Location ID
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