STUDENT RACE AND ETHNICITY REPORTING SURVEY

Please complete once for the duration of your enrollment at WMCSD-(This from is NOT annual)

Student Name:*
Please Enter Child's Birth Date*
Please select one*
Who is the person completing this survey?*
Person completing this survey is doing so with the most accuracy and to the best of their knowledge.
Is this student Hispanic/Latino?*
- No, NOT Hispanic/Latino
- Yes, Hispanic/Latino (A person of Cuban, Mexican, Puerto Rican, Cuban, South or Central American, or other Spanish culture or origin, regardless of race.)
***Answers to the following will be held strictly confidential and data will be used only in the aggregate***
What is the students race?*
- American Indian or Alaska Native (A person having origins in any of the original peoples of North and South American, including Central American, and who maintains tribal affiliation or community attachment.)
- Asian (A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.)
- Black or African American (A person having origins in any Black racial groups of Africa.)
- Native Hawaiian or Other Pacific Islander (A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.)
- White (A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.)
(choose one or more)