1 Start 2 Complete Please select your race from the following choices. American Indian or Alaskan Native Asian Black or African American Native Hawaiian or Pacific Islander White More Than One Race Prefer Not to Disclose Please select your ethnicity. Hispanic/Latino Non-Hispanic/Non-Latino Prefer Not to Disclose Do you consider yourself to be from a disadvantaged background? Yes No Prefer Not to Disclose Do you consider yourself to be from a rural background? Yes No Prefer Not to Disclose Are you a veteran of the U.S. armed forces? Yes No Prefer Not to Disclose What was your gender assigned at birth? Female Male Prefer not to disclose What is your current age in years? If you are a health professions student, which profession are you preparing to enter? If you would like updates on the ICARE program and its resources, please feel free to provide your contact information. This information will only be used to provide ICARE updates. (Name and email) Leave this field blank
