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For educational and funding reporting purposes, Close Up requests that you provide the following demographic information. Such information will remain confidential and will not be used at any time for selection or placement criteria for the Close Up programs. Please complete all items below. Your cooperation is greatly appreciated.

1. Are you are a member of a farm/migrant community:  
2. Which best describes your school district?  
3. Check here if you are Hispanic or Latino:  
4. Which best describes you? (please select one or more):  
American Indian or Alaska Native
Black or African American
Native Hawaiian or Other Pacific Islander
5. Check here if you are a citizen of the United States:  

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