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(P.O. Box, Village & Island) (5). SEX (7). PHONE # (8). EMERGENCY CONTACT PERSON & PHONE # (9). SELECTIVE SERVICE (Males Only) Registered ( ) Not Registered ( ) Not Applicable ( ) Reg. # White Black Hispanic Alaska/Am. Ind. Asian/Pacific Is. Other ( ( ( ( ( ( (10). PLACE OF BIRTH Within past 6 months Case # Amount of Grant $ Receiving SSI? Yes ( ) Claim # ) (18). EDUCATION STATUS: Student School Drop Out Graduated HS/GED Post High School Highe.

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