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| What year are you in college? |
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| Do you have a learning disability? |
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| Do you have a diagnosed mental disability? |
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| Do you have a physical disability that seriously effects your schoolwork? |
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| Have you ever been a victim of child abuse? |
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| Have you ever experienced parental domestic abuse? (Physical abuse of one parent by another) |
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| Have you ever been a victim of sexual abuse? |
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| Were either of your parents completely absent throughout your life? |
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| Are your parents legally divorced or separated? |
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