JfL Student Application JfL Student Form Name * First Last * Last Gender * Male Female Address * City, State, Zip * Email * Phone Number * Date of Birth * Ethnicity * Caucasian African American Native American Hispanic Asian Other Check all that apply Are you a United States Citizen? * Yes No If no, can you provide proof of residency? Yes No Are you currently legally authorized to work? * Yes No If no, are yo in process of securing work authorization? Yes No Will you be able to provide the following forms: * US Social Security Card US Green Card Driver's License Check all that are "Yes" Please list any physical handicaps or other special needs: Check the highest grade completed: * 4th grade 5th grade 6th grade 7th grade 8th grade 9th grade 10th grade 11th grade 12th grade/ GED Vocational Training Junior College College Graduate School Did you receive a certificate or diploma from a college or training facility? * Yes No If yes, what training/degree did you receive?