Fall 2022
1223 Cohort - Level 3
Date:
-
Month
-
Day
Year
Date
The following information is required for reporting purposes. Your answers will be kept confidential. Please note that your name is not requested.
Age:
*
16-20
21-25
26-30
31-40
41-50
51-60
Gender:
*
Female
Male
Marital Status
*
Single
Married
# of Dependents
*
0
1
2
3
4
5
Other
Ethnic Origin:
*
White (Not of Hispanic Orgin)
Hispanic or Latino
American Indian and Alaska Native
Black/African American
Asian
Native Hawaiian or other Pacific Islander
Two or More Races
Other
What City were you born in?
What State were you born in?
Student Residency
In-state resident
Out of state resident
Other
Are you an International student?
Yes
No
If yes, from what Country?
What is your first language?
While in college, where do you live?
on campus
off campus
Other
Military Information
active duty
military dependent
reserve duty
veteran
not applicable
What types of financial aid you are receiving?
Submit
Should be Empty: