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Name (Initial + Last Name) *

Age (Years/DOB) *

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Education *

Career *

Marital Status *

Religion *

Are you a US-based Muslim medical
professional (MD, DO, dentist, nurse,
resident, medical student, IMG in residency,
or allied health professional)?*

Yes

Are you a highly educated non-medical
professional (e.g., attorney, engineer, CEO,
MBA, MPH, PhD, finance, software/MS
engineering, astronaut, pilot, *

Yes

If not in the U.S., are you an IMG (Residency
Matched) or a highly educated non-medical
professional (minimum Master’s degree) on a
student or employm*

Yes

Are you at least 23 years old?*

Yes

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