Questionnaire Text

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6. What is this person's race? Mark [X] one or more races to indicate what this person considers himself/herself to be.
[] White
[] Black, African Am., or Negro
[] American Indian or Alaska Native - Print name of enrolled or principal tribe.

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[] Asian Indian
[] Chinese
[] Filipino
[] Japanese
[] Korean
[] Vietnamese
[] Other Asian - Print race.

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[] Native Hawaiian
[] Guamanian or Chamorro
[] Samoan
[] Other Pacific Islander - Print race.

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[] Some other race - Print race.

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