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3/17/2016

PracticeApplication:Page2

PERSONALINFORMATION
ApplicantInformation
SocialSecuritynumber:^ 000000000

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ReenteryourSocialSecuritynumber
(forverification): 000000000

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^ProvidingtheSocialSecuritynumberisvoluntary,isrequestedbytheinstitutionsolelyforadministrativeconvenienceand
recordkeepingaccuracy,andisrequiredonlytoprovideapersonalidentifierfortheinternalrecordsofthisinstitution.Please
beawarethatFinancialAidcannotbeassignedwithoutavalidSocialSecurityNumberonfileatthisinstitution.

NCStudentNumber:^^ 12414741
Screen2

^^YourNCStudentNumber(formerlyNCWISEStudentID)isyourNorthCarolinapublichighschoolstudentidentifier
numberandisonlyapplicabletoNorthCarolinaHighSchoolstudents.ProvidingtheNCStudentNumberisvoluntaryandif
provided,willgiveyoutheopportunitytorequestyourhighschooltranscriptelectronically.

Dateofbirth:* 11/24/2001

mm/dd/yyyy

Placeofbirth
City:* Rochester
U.S.state/territory:* NewYork
Samantha,
ifyouhaveany
technicalquestions,
clickhere.

Country: UnitedStatesofAmerica
Thefollowinginformationwillnotbeusedinadiscriminatorymanner.Thisdataisusedfor
statisticalpurposesonly.
Gender:* Female
Ethnicity
AreyouHispanicorLatino? No
Hispanic/Latino:Mexican,PuertoRican,Cuban,CentralorSouth
AmericanorotherSpanishoriginorculture,regardlessofrace

Race

Selectoneormoreofthefollowing
racialcategories:

AmericanIndianorAlaskaNative
Asian
BlackorAfricanAmerican
NativeHawaiianorOtherPacificIslander
White

Citizenshipstatus:* U.S.citizenship
Ifdual,selectothercitizenship: Clickhere
*=Required

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