SECTION 1: Student Information

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Page 1 of 6 Student s Legal Name / Vital Information : ________________________________________ ______________________________ (Last) (First) (Middle) (Suffix) _______________________________ (Preferred First Name) Date of Birth:______/_______/______ Gender: M F Place of Birth: City:__________________________State:___ ____Country:_____________________ If born outside US: date arrived in US: ______/_______/______ first time in US School: ______/_______/______ Grade:________ Date Entered 9th Grade (if applicable): ______/_______/______ Social Security Number:______-_____-______ (voluntary) I understand that my child s Social Security Number will be required for HOPE Scholarship eligibility.

Page 2 of 6 Federally Mandated Questions: Please answer both parts Part A - Ethnicity: Is the student Hispanic or Latino? (choose only one) No, not Hispanic/Latino Yes, Hispanic/Latino (A person of Cuban, Mexican, Puerto Rican, South or Central American,

  Information, Students, Student information