Presidential Scholars Voluntary Survey Form

PRESIDENTIAL SCHOLARS PROGRAM

VOLUNTARY SURVEY FORM


The following information is requested on a voluntary basis.  The information will be used for statistical purposes only and will remain confidential.

Please check one.

Hispanic or Latino

A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.

Not Hispanic or Latino

Please check the box(es) next to the race with which you most closely identify.  You may choose all that apply.

 American Indian or Alaska Native
        A person having origins in any of the original peoples of North and South America (including Central America), and who maintains tribal affiliation or community attachment.
       
 Asian
        A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.
       
 Black or African American
        A person having origins in any of the black racial groups of Africa.
         
 Native Hawaiian or Other Pacific Islander
        A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
       
 White
        A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.
   

Do you consider yourself to be physically challenged or disabled?       Yes     No

If so, please briefly describe your disability: