| Name (first, mi, last): |
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| Address line 1: |
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| Address line 2: |
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| City, State, Zip: |
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| Cell Phone: |
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| Email Address: |
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| Verify your email address: |
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| Date of Birth: |
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Colleges and universities are asked by many groups, including the federal government, accrediting associations, college guides, and
newspapers, to describe the ethnic/racial backgrounds of their students and employees. In order to respond to these requests, we ask
you to answer the following questions:
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| Your Gender: |
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| Are you Hispanic or Latino? |
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| Regardless of your answer to the prior question, please check one or more of the following groups in which you consider yourself to be a member: |
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or other Pacific Islander
White
Prefer not to answer |
| Semester you want to take courses: |
Fall
Spring
Summer
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| Home Institution: |
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