Fillable New OIP Student Info ID Number Zip Code

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New OIP Student Info ID Number Zip Code

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L
a
s
t
High
School
a
tt
e
nd
e
d
S
t
a
t
e
/
C
oun
t
r
y
Years
A
tt
e
nd
e
d
:
to
G
r
a
du
a
t
e
d
?
Yes
N
o
L
a
s
t
college,
v
o
c
/
t
e
c
h
,
un
i
v
e
r
s
i
t
y
a
tt
e
nd
e
d
S
t
a
t
e
/
C
oun
t
r
y
Years
A
tt
e
nd
e
d
:
to
G
r
a
du
a
t
e
d
?
Yes
N
o
New OIP Student Info
S
t
ud
e
n
t
Name
L
a
s
t
(Surname)
F
i
r
s
t
Middle In
i
t
i
a
l
S
t
ud
e
n
t
ID Number
B
i
r
t
hd
a
t
e
MM-
DD
-
YYYY
S
t
r
ee
t
Address
Ap
t
.
#
City
S
t
a
t
e
Zip Code
Email
Address
Cell Phone
Home Phone
Previous
N
a
m
e
(
s
)
Male Female
F
i
r
s
t
qu
a
r
t
e
r
:
S
U
M
FALL WTR
S
P
R
20
Services
are
available
for
s
t
ud
e
n
t
s
who have
special needs
due
to
a d
i
s
a
b
ili
t
y
.
Would you like our
s
t
a
ff
to
c
on
t
a
c
t
y
ou
A.
with
more
i
n
f
o
r
m
a
t
i
on
?
Yes
N
o
W
h
a
t
i
s
y
ou
r
v
i
s
a
t
y
p
e
?
·
If
your
visa
type
is
B, F, J,
M
,
or TN you
m
u
s
t
go
t
h
r
ou
g
h
the In
t
e
r
n
a
t
i
on
a
l
S
t
ud
e
n
t
Services
O
ff
i
c
e
.
·
If
your
visa
type
is
A, E, G,
H
,
I, K, L,
or
R
the
E
n
r
o
ll
m
e
n
t
Services
Office
will
a
ss
i
s
t
you.
B.
·
If
you do
not
have a
visa,
what
is your
s
t
a
t
u
s
:
I
am
a
US
c
i
t
i
z
e
n
O
t
h
e
r
(
p
l
e
a
s
e
e
x
p
l
a
i
n
)
C.
Turn over
for
more qu
e
s
t
i
on
s
Edmonds
C
o
mm
un
i
t
y
College does
not d
i
s
c
ri
m
i
n
a
t
e
on the
basis
of
race;
color; religion; n
a
t
i
on
a
l
origin;
sex; d
i
s
a
b
i
l
i
t
y
;
sexual
o
ri
e
n
t
a
t
i
on
;
age;
c
i
t
i
z
e
n
s
h
i
p
,
m
a
ri
t
a
l
,
or v
e
t
e
r
a
n
s
t
a
t
u
s
;
or
g
e
n
e
t
i
c
information in
i
t
s
programs
and
a
c
t
i
v
i
t
i
e
s
.
The nond
i
s
c
ri
m
i
n
a
t
i
on
language
is
available
in
m
u
l
t
i
p
l
e
languages
a
t
e
d
cc
.
e
du
/
nond
i
s
c
ri
m
i
n
a
t
i
on
.
Pg.
1
Rev.
2
/
2
/
2017
Which
race(s)
do you consider
y
ou
r
s
e
l
f
to
be?
(
Op
t
i
on
a
l
)
(
M
a
r
k up
to two b
o
x
e
s
)
Alaska
N
a
t
i
v
e
(
015
)
Cambodian
(
604
)
Indonesian
(
610
)
Samoan
(
655
)
American Indian
(
597
)
*
Chinese
(
605
)
Japanese
(
611
)
Taiwanese
(
606
)
Arabian
(
801
)
Asian,
Indian
(
600
)
Asian,
Other
(
621
)
Black
or African American
(
872
)
Eskimo
(
935
)
Fijian
(
676
)
Filipino
(
608
)
Hawaiian,
N
a
t
i
v
e
(
653
)
Korean
(
612
)
Nepali
(
635
)
P
a
c
i
f
i
c
Islander,
Other
(
681
)
P
a
k
i
s
t
a
n
i
(
616
)
Thai
(
618
)
T
li
n
g
i
t
(
017
)
V
i
e
t
n
a
m
e
s
e (
619
)
White
(
800
)
D
.
O
t
h
e
r
R
a
c
e
:
*
I
f
A
m
e
r
i
c
a
n Ind
i
a
n
,
p
l
e
a
s
e
li
s
t
n
a
m
e
o
f
e
n
r
o
ll
e
d o
r
p
r
i
n
c
i
p
a
l
t
r
i
b
e
:
Are you
of
S
p
a
n
i
s
h
/
H
i
s
p
a
n
i
c
o
r
i
g
i
n
?
(
Op
t
i
on
a
l
)
(Please
mark only one bo
x
)
N
o
,
(
no
t
S
p
a
n
i
s
h
/
H
i
s
p
a
n
i
c
)
(
999
)
Yes,
Ce
n
t
r
a
l
American
(
704
)
Yes, Cuban
(
709
)
Yes,
M
e
x
i
c
a
n
,
M
e
x
i
c
a
n
-
A
m
.
,
Chicano
(
722
)
Yes,
P
u
e
r
t
o
Rican
(
727
)
Yes,
S
ou
t
h American
(
729
)
Yes, Spanish
(
731
)
Ye
s
,
o
t
h
e
r
S
p
a
n
i
s
h
/
H
i
s
p
a
n
i
c
:
How long do you plan
to
a
tt
e
nd
Edmonds
C
o
mm
un
i
t
y
C
o
ll
ege
?
One qu
a
r
t
e
r
(
11
)
Two qu
a
r
t
e
r
s
(
12
)
One year
(
13
)
Up
to two
years,
no
degree
planned
(
14
)
Long enough
to
c
o
m
p
l
e
t
e
a
degree
(
15
)
D
o
n
’
t
know
(
16
)
What
is your
c
u
rr
e
n
t
work
s
t
a
t
u
s
while
a
tt
e
nd
i
n
g
c
o
ll
ege
?
Not
employed,
but
seeking
e
m
p
l
o
y
m
e
n
t
(
15
)
Not
employed,
not
seeking
e
m
p
l
o
y
m
e
n
t
(
16
)
E.
What
was your
m
o
s
t
r
e
c
e
n
t
e
du
c
a
t
i
on
a
l
level
c
o
m
p
l
e
t
e
d
?
Less
t
h
a
n high school
g
r
a
du
a
t
i
on
(
11
)
GED
(
12
)
High school
g
r
a
du
a
t
e
(
13
)
Some p
o
s
t
high
school,
but
no
degree
or
c
e
r
t
i
f
i
c
a
t
e
(
14
)
Certificate (less than two years) (15)
Associate degree (16)
Bachelor’s degree or above (17)
Please check
the
one
that
applies
to
you. I am:
a
single p
a
r
e
n
t
with
children or
other d
e
p
e
nd
e
n
t
s
in your care
(
11
)
a couple
with
children or
other d
e
p
e
nd
e
n
t
s
in your care
(
12
)
without
children or
other d
e
p
e
nd
e
n
t
s
in your care
(
13
)
I herby
certify
under p
e
n
a
l
t
y
of
perjury under
the
laws
of the
s
t
a
t
e
of W
a
s
h
i
n
g
t
on RCW 9A.72.085
that to the b
e
s
t
of
my kno
wl
e
d
ge
,
all
s
t
a
t
e
m
e
n
t
s
on
t
h
i
s
form
are
true
and
c
o
rr
e
c
t
.
F.
S
i
g
n
a
t
u
r
e
:
D
a
t
e
:
OFFICE USE
ONLY
SS
N
/
N
A
M
E
CHEC
K
RESIDENCY C
O
D
E
2
FEE PAY
S
T
A
T
U
S
TYPE COUNTRY
CODE
DATE ENTERED
ENTERED
BY AUDITED DATE AUDITED BY
P
r
i
n
t
N
a
m
e
:
S
t
ud
e
n
t
I
D
N
u
m
b
e
r
OIP
S
t
ud
e
n
t
Bio
Pg.
2
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