Medicare: An In-Depth Look

Registrant's Information

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Demographic Information:

• Please take a few minutes to share some information about yourself. K-State Extension programs are open to everyone. To ensure civil rights policy adherence and to maintain funding for quality programing, we are required to report program participant race and gender data to the United States Department of Agriculture (USDA). Only aggregated information (total numbers across all programs) about race and gender are reported to the USDA. Providing the following information is voluntary and will be maintained strictly for reporting purposes. These records are kept separately from mailing lists and other participant information. Thank you for taking the time to provide us with this information.

• I identify my gender as: --Choose-- Female Male Prefer not to respond
• I identify my race as: --Choose-- American Indian or Alaska Native Asian African American or Black Native Hawaiian or Pacific Islander White Two or more mixed races Prefer not to respond
• I identify my ethnicity as: --Choose-- Hispanic/Latino Non Hispanic/Latino Prefer not to respond
• I identify my age as: --Choose-- Under 5 years of age 5-17 years 18-29 years 30-59 years 60+ years Prefer not to respond

Guest Information

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Guest Demographic Information

• I identify my gender as: --Choose-- Male Female Prefer not to respond
• I identify my race as: --Choose-- American Indian or Alaska Native Asian African American or Black Native Hawaiian or Pacific Islander White Two or more mixed races Prefer not to respond
• I identify ethnicity as: --Choose-- Hispanic/ Latino Non Hispanic/Latino Prefer not to repsond
• I identify my age as: --Choose-- Under 5 years of age 5-17 years 18-29 years 30-59 years 60+ years Prefer not to respond