Is this child Hispanic/Latino? Yes No If yes, check all that apply: Argentinian Guatemalan Salvadoran Bolivian Honduran Spanish Chilean Mexican or Mexican-American Uruguayan Colombian (Chicano) Venezuelan Rican Nicaraguan Latin American Cuban Panamanian Other Hispanic or Latino Dominican Peruvian (describe)____________________ Ecuatorian (Ecuadorian) Puerto Rican What race(s) do you consider this child? (Check all that apply) White Quinault Maldivian Samish Mongolian Black or African American Sauk-Suiattle Nepali Shoalwater Pakistani Skokomish Singaporean Alaska Native Snohomish Sri Lankan Aleut (Unangan) Snoqualmie Taiwanese Alutiiq Snoqualmoo Thai Athabaskan Spokane Vietnamese Eskimo (Inupiaq or Yupik) Squaxin Island Other Asian Eyak Steilacoom (describe)_______________ Haida Stillaguamish Tlingit Suquamish Tsimshian Swinomish Other Alaska Native Tulalip Native Hawaiian or Other Pacific (describe)_______________ Skagit Islander Yakama Fijian Other American Indian Guamanian (describe)_______________ Kosraean American Indian Mariana Islander Chehalis Marshall Islander Chinook Melanesian Colville Asian Micronesian Cowlitz Asian Indian Native Hawaiian Duwamish Bangladeshi Palauan Hoh Bhutanese New Guinean Jamestown Burmese Ponapean (Pohnpeian) Kalispel Cambodian/Kampuchean Samoan Kikiallus Chinese Solomon Islander Lower Elwha Filipino Tahitian Lummi Hmong Tarawa Islander Indonesian Tokelauan Muckleshoot Japanese Tongan Nisqually Korean Trukese (Chuukese) Nooksack Laotian Vanuatuan/New Hebrides Port Gamble Klallam Madagascar Yapese Puyallup Malayan Other Pacific Islander Quileute (describe)_______________
Is this child Hispanic/Latino? Yes No If yes, check all that apply: Argentinian Bolivian Chilean Colombian Rican Cuban Dominican Ecuatorian (Ecuadorian) Guatemalan Honduran Mexican or Mexican-American (Chicano) Nicaraguan Panamanian Peruvian Puerto Rican Salvadoran Spanish Uruguayan Venezuelan Latin American Other Hispanic or Latino (describe)____________________ What race(s) do you consider this child? (Check all that apply) White Black or African American Alaska Native Aleut (Unangan) Alutiiq Athabaskan Eskimo (Inupiaq or Yupik) Eyak Haida Tlingit Tsimshian Other Alaska Native (describe)_______________ American Indian Chehalis Chinook Colville Cowlitz Duwamish Hoh Jamestown Kalispel Kikiallus Lower Elwha Lummi Muckleshoot Nisqually Nooksack Port Gamble Klallam Puyallup Quileute Quinault Samish Sauk-Suiattle Shoalwater Skokomish Snohomish Snoqualmie Snoqualmoo Spokane Squaxin Island Steilacoom Stillaguamish Suquamish Swinomish Tulalip Skagit Yakama Other American Indian (describe)_______________ Asian Asian Indian Bangladeshi Bhutanese Burmese Cambodian/Kampuchean Chinese Filipino Hmong Indonesian Japanese Korean Laotian Madagascar Malayan Maldivian Mongolian Nepali Pakistani Singaporean Sri Lankan Taiwanese Thai Vietnamese Other Asian (describe)_______________ Native Hawaiian or Other Pacific Islander Fijian Guamanian Kosraean Mariana Islander Marshall Islander Melanesian Micronesian Native Hawaiian Palauan New Guinean Ponapean (Pohnpeian) Samoan Solomon Islander Tahitian Tarawa Islander Tokelauan Tongan Trukese (Chuukese) Vanuatuan/New Hebrides Yapese Other Pacific Islander (describe)_______________
Combined_prescreen_and_application.docx