Sex

• Female
• Male

Citizenship

• U.S.
• International Student
• Permanent Resident

State of Residence

Minority Background

• African American/Black
• Alaskan Native
• American Indian
• Asian American/ Pac. Islander
• Hispanic, Other
• Mexican American/Chicano
• Puerto Rican

Student's Disability

• Deaf/hearing impaired
• Learning disabled
• Physically disabled

Blindness

• Parent blind/visually disabled
• Student blind/visually disabled

Parent or Spouse Killed in Work Related Accident as:

• Fire Fighter
• Other
• Police Officer

Ethnic Background(s)

Religious Affiliation(s)

Special Conditions

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