ACE Student Information Form

Legal First Name*Please provide your Legal first name

Middle Initial*

Legal Last NamePlease enter your Legal Last Name

Street Address*

City*

State*

Zip Code*

County*

Social Security Number _ _ _-_ _-_ _ _ _Enter in this format: XXX-XX-XXXX (Providing your Social Security number is voluntary, however, the IRS requires students to furnish a TIN number - for most students that is a Social Security number. Failure to do so may result in a student receiving an IRS fine.)

Date of Birth*(MM/DD/YYYY)

Student's Email Address*Enter a working email for communication re: ACE

Student's Cell Phone Number*

Parent Cell Phone Number

Legal Sex*

Female

Male

Prefer not to answer

What are your Career Interests? *List a Career Interest or indicated "Undecided"

Are you a US citizen*

Yes

No

Are you Hispanic/Latino*

Yes

No

If Hispanic/Latino, is your background (select one):

Central American

Dominican

Mexican

Other Hispanic/Latino

Puerto Rican

South American

All students, please indicate your race background (select one or more):*

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian or Other Pacific

White

High School *Enter the High School you attend

Expected Graduation Year (Example: 2021)*

If you have questions about the use of this information, please contact us at 607-962-9533 or ace@corning-cc.edu.

The Personal Privacy Protection Law requires this notice to be provided when collecting personal information from individuals. The authority to request this information is found in section 355 (2) (i) of the Education Law.