{{ block content }} Answer the following questions:

What is your gender?
{{ formfield 'gender' label=''}}

What is your age?
{{ formfield 'age' label=''}}

What is your race?
(Select all that apply)
White
Black or African American
Asian
American Indian or Alaska Native
Native Hawaiian or Other Pacific Islander
Other

Are you of Hispanic, Latino, or Spanish origin?
{{ formfield 'hispanic' label=''}}


In which state did you reside before college?
{{ formfield 'residence' label=''}}


{{ endblock }} {{ block style }} {{ endblock }}