Rev. 2/10
Ethnic / Heritage Change Form
Student ID _____________________________
Print
Yes
name ____________________________________ Email Address ______________ @____________
Race/Ethnic Data
Please check all that apply
Is your ethnic heritage Hispanic/Latino? (H)
No
Is your race? (Check all that apply)
American Indian/Alaskan Native (I)
Asian (A)
Native Hawaiian or Pacific Islander (P)
Black (B)
White (W)
Student Signature __________________________________________ Date ________________________
(Required)
Note* Submit form to the Campus Admissions office to update your Race / Ethnic Data
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