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150 appendix k Participant Background Information Form Name: ____________________________________________________ Street Address: _____________________________________________ City: ____________________ State: _______ Zip: _____________ Age: _________ Sex: M F Do you have: High School Diploma? ______________________________________ Associate’s Degree? ______ Major ____________________________ Bachelor’s Degree? ______ Major ____________________________ Master’s Degree? ________ Major ____________________________ Other ____________________________________________________ What do you consider your dominant language? ________________ How often do you use an interpreter? _________________________ Signature_________________________________ Date________________ ...

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