Select only one best response for the following questions.
How long do you plan to attend Columbia Basin College?
11 One quarter
12 Two quarters
13 One year
14 Up to two years, no degree planned
15 Long enough to complete a degree
16 Don’t know
What is your current work status while attending college?
11 Full-time homemaker
12 Full-time employment (including self-employed and military)
13 Part-time o-campus
14 Part-time on-campus
15 Not employed, but seeking employment
16 Not employed, not seeking employment
What is your prior level of education at entry to Columbia Basin College?
11 Less than high school graduation
13 High school graduate
14 Some post high school, but no degree or certiﬁcate
15 Certiﬁcate (less than two years)
16 Associate's degree
17 Bachelor’s degree or above
What was your family status when you started at Columbia Basin College?
11 A single parent with children or other dependents in your care
12 A couple with children or other dependents in your care
13 Without children or other dependents in your care
How long have you resided in Washington state?
Were you ﬁnancially independent from your parent or legal guardian for the
previous calendar year? Yes No
If NO, how long has your parent or legal guardian resided in Washington state?
Are you active duty military, spouse or dependent child of same? Yes No
If YES, when was the active duty military person ﬁrst stationed in Washington?
Are you a higher education employee or dependent? Yes No
Last High School Attended City State Year Graduated
Last College Attended City State Year Graduated
What is your main long-term goal for attending Columbia Basin College?
11 Take courses related to current or future work
12 Transfer to a four-year college
13 High school diploma or GED
14 Explore career direction
15 Personal enrichment
Please mark one or more boxes to indicate
what race you consider yourself to be.
African American (870)
American Indian (597)
Alaskan Native (015)
Native Hawaiian (653)
Other Paciﬁc Islander (681)
Other Asian (621)
Other Race (Please specify)
Are you of Spanish/Hispanic origin?
Yes, Mexican, Mexican American, Chicano
Yes, Puerto Rican (727)
Yes, Cuban (709)
Yes, Other Spanish/Hispanic/Latino
Gold Card (60 yrs and older) Senior Fitness Only (55 to 59 yrs)
Driver’s License/ID Required
Community User - Fitness Center Only
Please complete the box below.
If NOT a U.S. Citizen, what is your immigration status?
Student (F-1) Visitor Immigrant/Permanent Resident (IM)
Student Intent Codes:
A --- General Studies Degree or Certiﬁcate
B --- Academic Transfer
D --- High School Diploma/GED Certiﬁcate
E --- Development
F --- Occupational Preparatory
G --- Occupational Preparatory Applicant
H --- Occupational Apprentice
J --- Occupational Supplement
K --- Vocational Home and Family Life
L --- General Studies (no degree or certiﬁcate)
W --- Community Service
X --- Undecided
Y --- None of the above
For Ofﬁcial Use Only