Date:
-
Month
-
Day
Year
Date
Level 1
Fall 2026
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
61+
Gender:
*
Female
Male
Other
Marital Status
*
Single
Married
# of Dependents
*
0
1
2
3
4
5
Other
Race:
White
Black/African American
American Indian and Alaska Native
Asian
Native Hawaiian or Pacific Islander
Two or more races
Are you a First Generation College Student?
Yes
No
Other
What State or non-US Country were you born in?
Are you an international student (i.e. not a US citizen or permanent resident)?
Yes
No
What is your first language?
While in college, where do you live?
on campus
off campus
Other
Please list the types of financial aid you are receiving.
Why did you decide to go into Nursing?
Student Residency
In-state resident
Out-of-state resident
Other
Military Information
active duty
military dependent
reserve duty
veteran
not applicable
Submit
Should be Empty: