McCollum Scholars Program Personal Information Question Title * 1. What is your full name? Question Title * 2. What is your school email address? Question Title * 3. What is your personal email address? Question Title * 4. Home telephone number Question Title * 5. Mobile Phone number Question Title * 6. Gender Female Male Non-binary/Non-conforming Transgender Prefer not to respond Question Title * 7. Race American Indian or Alaska Native Asian or Asian American Black or African American White Hispanic or Latino Native Hawaiian or other Pacific Islander Multi-racial Prefer not to say Question Title * 8. Ethnicity Hispanic Non-hispanic Question Title * 9. Citizenship Asylee Conditional Permanent Resident Cuban or Haitian Entrant FAFSA-Eligible Non-Citizen Humanitarian Parolee Refugee or Protected Person Resident Alien or Permanent Resident U.S. Citizen Question Title * 10. What is your home address? Question Title * 11. What is your guardian's full name? Question Title * 12. What is your guardian's email address? Question Title * 13. What is your guardian's mobile phone number? Question Title * 14. Does your family qualify for any government assistance(ex. SNAP benefits, Section Eight, free or reduced lunch)? Yes No Question Title * 15. What is the highest level of education your parent(s) or guardian have received? Less than high school degree High school degree or equivalent(e.g. GED) Some college but no degree Associate Degree Bachelor Degree Graduate Degree Question Title * 16. How much total combined income did all members of your household earn last year? Under $15,000 Between $15,000 and $29,999 Between $30,000 and $49,999 Between $50,000 and $74,999 Between $75,000 and $99,999 Between $100,000 and $150,000 Over $150,000 Page1 / 5 20% of survey complete. Next
