Engineering Academy 2019 Personal Info Question Title * 1. What is your name? (First and Last) Question Title * 2. What is your cell phone number? Question Title * 3. Family contact (name, relation, phone) Question Title * 4. Please provide your UCSC email address. Question Title * 5. What is your gender identity? Woman Man Non-binary Other Question Title * 6. Please provide your ethnicity. Check as many as apply. American Indian or Alaskan Native Asian or Pacific Islander Black or African American Hispanic or Latino White / Caucasian Other (please specify) Question Title * 7. Date of birth (MM/DD/YY) Question Title * 8. Do you consider yourself a first generation college student? Yes No Question Title * 9. What do you prefer to be called? (This is for your name tag.) Question Title * 10. What is your t-shirt size? S M L XL Other (please specify) Question Title * 11. Do you require any special accommodations (dietary or disability-related)? Question Title * 12. How did you hear about this program? Next
