Exploring Health and Human Service Careers Application Question Title * 1. Today’s Date Question Title * 2. Student's First Name Question Title * 3. Student's Last Name Question Title * 4. Student's Date of Birth Date / Time Date Question Title * 5. Student's Age Question Title * 6. Student's Gender Female Male Prefer not to answer Question Title * 7. Student's Ethnicity Hispanic or Latino Non-Hispanic or Latino Prefer not to answer Question Title * 8. Student's Race American Indian or Alaska Native Asian Black or African American White or Caucasian Native Hawaiian or Pacific Islander More than one race Prefer not to answer Question Title * 9. Student Phone Number Question Title * 10. Student Email Address Question Title * 11. Student Secondary Email is needed. Some emails (like school accounts) may not allow all emails to be received from outside contacts, so please provide another email address. Question Title * 12. Student Address Street Address City State Zip Code Question Title * 13. Student's School Question Title * 14. Grade Level 6th 7th 8th 9th 10th 11th (mentor) 12th (mentor) Current college student College graduate Other (please specify) Question Title * 15. Shirt Size: Youth Large Adult Small Adult Medium Adult Large Adult X-Large Other (please specify) Next