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ME OF VOLUNTEER OR GROUP LEADER COMPLETING FORM (Last, First) NAME OF GROUP (if applicable) U.S. CITIZEN OR PERMANENT RESIDENT D Yes, I am a U.S. citizen or Permanent Resident D No, I am not a US Citizen or Permanent Resident 5. STREET ADDRESS, APT# 6. CITY 7. 9. DATE OF BIRTH 10. PHONE 11. (if applicable, list visa type STATE 8. l ZIP CODE EMAIL ADDRESS 12. DEMOGRAPHIC INFORMATION (Optional): Please indicate both ethnicity and race and tell us if you are a veteran or have a di.
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