Student intake form Today - must be dd/mm/yyyy format Date Format: DD slash MM slash YYYY Legal namePreferred nameBirthdate - must be dd/mm/yyyy format Date Format: DD slash MM slash YYYY School (if attending)GradeHigh School FreshmanHigh School SophomoreHigh School JuniorHigh School SeniorCollege StudentNot presently in schoolYear of High School GraduationCurrent city of residenceCurrent zip codePhone numberEmail address GenderMaleFemalePrefer not to answerWhich categories describe you White Hispanic/Latino or Spanish origin Black or African American Asian American Indian or Alaska Native Middle Eastern or North African Native Hawaiian or Other Pacific Islander Some other race, ethnicity, or origin Do either of your parents have a Four-Year College DegreeYesNoHousehold type 2 parents Single parent Legal guardianship Homeless Foster care Other Household size- Please choose one -1234566+Estimated, annual family Income (in dollars)- Please choose one -0 - 16,99917,000 - 25,99926,000 - 34,99935,000 - 43,99944,000 - 54,99955,000+Do you qualify for free or reduced lunchYesNoI don't knowDo you qualify for government assistance (such as WIC, Food Stamps, Government Housing, etc.)YesNoI don't knowHow did you hear about the NACRC? AZ Daily Sun Radio Commercial Print Advertisement A friend At school E-mail Website Other CAPTCHA