[ ] White - Print, for example, German, Irish, English, Italian, Lebanese, Egyptian, etc. -->___________________________

[ ] Black or African Am. -Print, for example, African American, Jamaican, Haitian, Nigerian, Ethiopian, Somali, etc. -->_________________________

[ ] American Indian or Alaska Native -- Print name of enrolled or principal tribe(s), for example, Navajo Nation, Blackfeet Tribe, Mayan, Aztec, Native Village of Barrow Inupiat Traditional Government, Nome Eskimo Community, etc. --> ______________________
[ ] Chinese
[ ] Vietnamese
[ ] Native Hawaiian
[ ] Filipino
[ ] Korean
[ ] Samoan
[ ] Asian Indian
[ ] Japanese
[ ] Chamorro
[ ] Other Asian -- Print, for example, Pakistani, Cambodian, Hmong, etc. --> _____________________
[ ] Other Pacific Islander ? Print, for example, Tongan, Fijian, Marshallese, etc. -->______________________
[ ] Some other race -- Print race or origin. -->
____________________________________________________