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2. The Dubuque City Council values diversity on its boards and commissions. Your responses on this page provide valuable information to the Council to examine whether its boards and commissions are representative of the community it serves and help the City Clerk’s Office in examining whether we are reaching a diverse audience with our vacancy notifications for the boards and commissions. Providing the following information is optional, and the information will not be attached to your name or used for individual selection purposes. You may choose to provide as much or as little information as you like.

   Completing the following information is optional. It is considered confidential and will not be associated with individual applicant information nor used in the selection process.

   This information is used to assist staff in fulfilling City Council goals related equity and diversity.

4. Gender - choose all that apply:
   -- Select One --ManWomanTrans or transgender (please specify below)Another identity (please specify below)
6. Gender - additional information from above
8. Age category
   -- Select One --18-2122-3031-4041-5051-6061 & over
10. Please specify your race and/or ethnicity (please check all that apply):

    1. American Indian/Alaskan native
    2. Asian
    3. Black/African American
    4. Hispanic/Latino
    5. Native Hawaiian/Other Pacific Islander
    6. White
    7. Multi-racial (fill in the blank below)
    8. Other (fill in the blank below)
12. Race/Ethnicity - additional information from above
14. Do you identify as a person with a disability?
    -- Select One --YesNo
16. If you would like to provide information regarding the type of disability you have, please share below.
18. Formal education completed
    -- Select One --Did not complete high schoolHigh school graduateCollege graduateM.A. degree or equivalent level graduate degreeM.D., Ph. D. degree or equivalent level graduate degreeOther (fill in the blank below)
20. Education - additional information from above
22. Language(s) you speak in addition to English:
24. How many years have you lived in Dubuque?
26. How many generations of your family has lived in the United States?
    -- Select One --First generation AmericanSecond generation AmericanThird generation AmericanFourth generation American or more
28. Household income
    -- Select One --Less than $10,000$10,000 to $49,999$50,000 to $149,999$150,000 or more
30. Please rate your comfort level with using technology (phones, tablets, computers):
    -- Select One --Very comfortableSomewhat comfortableSomewhat uncomfortableVery uncomfortable
32. Please describe any potential challenges you may have participating on a board or commission. Examples could include transportation issues, lack of childcare access, work schedule, etc. * Note: This question is to help anticipate potential concerns for our boards and commissioners.
34. Federal law prohibits discrimination on the basis of race, color, religion, disability, sex, or national origin, as well as discrimination on the basis of age against persons over the age of 40. Some state and city legislation prohibits discrimination on the basis of age, marital status, sexual preference, race, color, religion, sex, national origin, or any other basis prohibited by law.
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