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Gender
 
Female
 
Male
 
 
 
Age
   
 
 
 
Nationality
   
 
 
 
Civil Status
 
Married
 
Single
 
Widow
 
In a relationship
 
 
 
Do you have children?
 
Yes
 
No
 
 
 
Where do you live? Indicate the region and city/village.
   
 
 
 
The highest degree of education completed:
 
Graduate degree (Masters or PhD)
 
University Degree (Bachelors)
 
High School Diploma
 
Did not complete high school. Indicate the highest grade completed______
 
No formal education