Form DM - Demographics
DM - Demographics
What is the subject's date of birth?
01 Jan 2000
What is the subject's age?
What is the age unit used?
Years
What is the sex of the subject?
Choose
Female
Male
Unknown
Undifferentiated
Do you consider yourself Hispanic/Latino or not Hispanic/Latino?
Choose
Hispanic or Latino
Not Hispanic or Latino
Not Reported
Unknown
Which of the following five racial designations best describes you? (More than one choice is acceptable.)
Choose
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Not Reported
Unknown
Other
What was the other race?
*
Mandatory field