DisArt

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First Name

Last Name

Address

Street Address Address Line 2 City State/Prov/Region Postal/Zip Country

What do you like most about DisArt?

Please check the most accurate description for you

I currently identify as disabled and have for my entire life.
I currently identify as disabled and have for significant portions of my life.
I currently identify as disabled and have for brief instances of my life.
I currently DO NOT identify as disabled, but have for brief instances in my life.
I currently DO NOT identify as disabled, but have for significant portions of my life.
I currently DO NOT identify as disabled, and have never identified as disabled.
I have a disability but do not identify as disabled.
I’m currently evaluating or questioning if I identify as disabled or if I could have identified as disabled at some point in my life.
I prefer not to answer

Which race(s)/ethnicity(ies) best describes you?

American Indian or Alaska Native— For example, Navajo Nation, Blackfeet Tribe, Mayan, Aztec, Native Village of Barrow Inupiat Traditional Government, Nome Eskimo Community
Asian— For example, Chinese, Filipino, Asian Indian, Vietnamese, Korean, Japanese, Afghan
Black or African American— For example, Kenyan, Nigerian, South African, Ghanaian, Gambian, Congolese
Hispanic, Latinx or Spanish Origin— For example, Mexican or Mexican American, Puerto Rican, Cuban, Salvadoran, Dominican, Columbian, Portuguese
Middle Eastern or North African— For example, Lebanese, Iranian, Egyptian, Syrian, Moroccan, Algerian
Native Hawaiian or Other Pacific Islander— For example, Native Hawaiian, Samoan, Chamorro, Tongan, Fijian, Marshallese
White or Caucasian — For example, German, Irish, English, Italian, Polish, French
Other not listed
I prefer not to answer