Birth Parent Your Mother Your Father Racial group (Check one) White (not Hispanic) White (not Hispanic) (not Hispanic) Black (not Hispanic) Black (not Hispanic) (not Hispanic) Hispanic Hispanic Hispanic Alaskan Native Alaskan Native Alaskan Native American Indian American Indian American Indian Yes No Enrolled Yes No Enrolled Yes No Enrolled Name of Tribe: Name of Tribe: Name of Tribe: Asian or Pacific Islander Asian or Pacific Islander Asian or Pacific Islander Other: Other: Other: Occupation Education completed. Indicate highest grade or if attended special education classes. If deceased, age at death and cause of death, if known. Are you of Ashkenazi Jewish Yes No Yes No Yes No descent? ARE YOU ADOPTED? Yes No Yes No Yes No SECTION IV DESCRIBE BIRTH PARENT'S BROTHERS AND SISTERS If additional space is needed, attach separate sheet. If Deceased, Cause and Age at Death, if Known Name Current (Last, First, Middle) Maiden Relationship Gender Birthdate Height Weight Sibling’s Children – 1. Full Male No. of males: Half Female No. of females: Step 2. Full Male No. of Half Female No. of females: Step 3. Full Male No. of males: Half Female No. of females: Step 4. Full Male No. of males: Half Female No. of females: Step 5. Full Male No. of males: Half Female No. of females: Step 6. Full Male No. of males: Half Female No. of females: Step
Birth Parent Your Mother Your Father Racial group (Check one) White (not Hispanic) Black (not Hispanic) Hispanic Alaskan Native American Indian Yes No Enrolled White (not Hispanic) Black (not Hispanic) Hispanic Alaskan Native American Indian Yes No Enrolled (not Hispanic) (not Hispanic) Hispanic Alaskan Native American Indian Yes No Enrolled Name of Tribe: Name of Tribe: Name of Tribe: Asian or Pacific Islander Asian or Pacific Islander Asian or Pacific Islander Other: Other: Other: Occupation Education completed. Indicate highest grade or if attended special education classes. If deceased, age at death and cause of death, if known. Are you of Ashkenazi Jewish descent? Yes No Yes No Yes No ARE YOU ADOPTED? Yes No Yes No Yes No SECTION IV DESCRIBE BIRTH PARENT'S BROTHERS AND SISTERS If additional space is needed, attach separate sheet. Name – Current (Last, First, Middle) Maiden Relationship Gender Birthdate Height Weight Sibling’s Children If Deceased, Cause and Age at Death, if Known 1. Full Half Step Male Female No. of males: No. of females: 2. Full Half Step Male Female No. of No. of females: 3. Full Half Step Male Female No. of males: No. of females: 4. Full Half Step Male Female No. of males: No. of females: 5. Full Half Step Male Female No. of males: No. of females: 6. Full Half Step Male Female No. of males: No. of females: