SUPRT-C Youth (12-17) Baseline

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06/08/2026Click to Sign
White
German
Irish
NO
Black or African American
English
Italian
Polish
French
Enter
Mexican or Mexican American
Puerto Rican
Cuban
Salvadoran
Dominican
Colombian
Enter_1
African American
Jamaican
Haitian
Nigerian
Ethiopian
Somali
Enter_2
Asian
Chinese
NO_1
Asian Indian
Vietnamese
Korean
Japanese
Enter_3
American Indian or Alaska Native
Specify for example Navajo Nation Blackfeet Tribe Mayan Aztec Native Village of Barrow
NO
Lebanese
Iranian
Egyptian
Syrian
Moroccan
Native Hawaiian or Pacific Islander
Israeli
Enter
Native Hawaiian
Samoan
Chamorro
Tongan
Fijian
Marshallese
Enter_1
A2
A3
American Sign Language ASL
Arabic
Chinese
French
Portuguese
Spanish
Other Language
checkbox_tyv
A4a
A4b
A4c
A4d
A4e
B1
B2
B3
B4
1
1b
x

Additional Signatures Required