Fanconi Anemia Survey

Please complete the attached anonymous survey. Your responses will be strictly
confidential and can never be linked to you. You may stop at any time. The data you
provide will be part of an Intel National Science Talent Search entry. Please answer
each question directly and honestly. Your effort is greatly appreciated.
Thank You.

What is your gender?

Male

Female

Age:

Where do you reside?

Are you a student?

Yes

No

I am a

Fanconi Anemia patient

Direct family member of a Fanconi Anemia patient

Neither of the above choices

Are you currently employed?

Yes

No

What is your ethnicity?

What is your relationship status?

The following questions refer to your behaviors in the past five months.