Study: Fuel Cell Powered TAH

Demographics

Date of birth
Gender	Male  Female  Unknown
Ethnicity (Hispanic or Latino)
Race (Select all that apply)	Native Asian Black PacificIslander White Unknown Other
Marital status	Single  Married  Divorced/Separated  Widowed  Unknown
Highest education level	None  Grade school(0-8)  High school(9-12)  Attended college/technical school  Associate/bachelor degree  Post-college graduate degree  N/A(<5 yrs old)  Unknown
Academic progress	Within One Grade Level of Peers  Delayed Grade Level  Special Education  N/A(< 5 yrs old)  Status Unknown
Academic activity level	Full academic load  Status Unknown  Reduced academic load  N/A(< 5 yrs old/High School Graduate)  Unable to participate in academic due to disease or condition
Working for income	Yes  No  Unknown
Not working reason	Disability  Demands of Treatment  Insurance Conflict  Inability to Find Work  Patient Choice - Homemaker  Patient Choice - Student Full Time/ Part Time  Patient Choice - Retired  Patient Choice - Other  N/A - Hospitalized  Unknown
Working Mode	Working Full Time  Working Part Time due to Demands of Treatment  Working Part Time due to Disability  Working Part Time due to Insurance Conflict  Working Part Time due to Inability to Find Full Time Work  Working Part Time due to Patient Choice  Working Part Time Reason Unknown  Working Part Time vs. Full Time Unknown