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About You

What prompted your donation?

Employer

Annual Household Income Less than $10,000 $10,000 to $19,999 $20,000 to $39,999 $40,000 to $59,999 $60,000 to $79,999 $80,000 to $99,999 $100,000 to $149,999 $150,000 to $199,999 $200,000 or more

How many people live in your household? 1 2 3 4 5 or more

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Do you consider yourself to have a disability?