| Name (first, mi, last): |
|
| Address line 1: |
|
| Address line 2: |
|
| City, State, Zip: |
|
| Cell Phone: |
|
| Email Address: |
|
| Verify your email address: |
|
| Date of Birth: |
|
|
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.
|
| |
|
| Your Gender: |
|
| Are you Hispanic or Latino? |
|
| 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
|
| Home Institution: |
|
|