Student Information Data Sheet

Legal Name:

Preferred Name:

Alias/Maiden Name:

Nationality:  American  Indian

 Australian  Irish
 Brazilian  Israeli
 Canadian  Japanese
 Chinese  Jordanian
 Cuban  Mexican
 English  Puerto Rican
 German  Scottish

Ethnicity: Are you Hispanic or Latino?  Yes  No

Select one of the following races:
 American Indian or Alaska Native
 Asian
 Black or African American
 Native Hawaiian or Other Pacific Islander
 White
 Two or more races

Citizen:  US Citizen
 Non-Citizen

Identified Gender:  Female  Male  Non-Binary

Military Veteran:  Yes  No

Previous Education:  High School Graduate

 High School Equivalency
 Ability to Benefit (ATB)
 Some College
 Still in High School

Student Signature: __________________________________ Date: _____________

Revised 1/14/2020