DNA Workshop Form

COLLEGEOFALAMEDA

COMMUNITY SERVCIES (FEE-BASED) REGISTRATION FROM

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SOCIAL SECURITY NUMBER

MONTH    DAY      YEAR

LAST NAME (Please print)

FIRST NAME

MIDDLE INITIAL

LOCAL MAILING ADDRESS

CITY                                   STATE

ZIP
(         )

(         )

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HOME PHONE NUMBER

DAYTIME PHONE NUMBER

BIRTHDATE

E-MAIL (Please print):
ENTER APPROPRIATE CODE IN FOLLOWING QUESTIONS:

GENER: [              ]1. Male2. Female
ETHNICITY: Enter code from below [         ]
A=AsianAC=ChineseAI=Asian IndianAJ=Japanese

AK=Korean

AL=Laotian

AM=Cambodian

AV=Vietnamese

AX=Other Asian

B=African American/BlackF=FilipinoH=HispanicHM=Mexican, Mexican American, Chicano

HR=Central American

HS=South American

HX=Other Hispanic

N=American Indian/Alaskan Native

O=Other Non-WhiteP=Pacific IslanderPG=GuamanianPH=Hawaiian

PS-Samoan

W=Whit Non-Hispanic

X=Unknown

XD=Decline to state

 

EDUCATIONAL LEVEL:  Enter code from below [        ]
NOT A HIGH SCHOOL GRADUATE:HIGH SCHOOL GRADUATE WITHOUT A COLLEGE DEGREE:
  1. Not a graduate of, and no longer enrolled in high school
  2. Currently enrolled in grade K-12 (special admit)
  3. Currently enrolled inAdultSchool

  1. Received a high school diploma
  2. Received a GED high school equivalency certificate
  3. Received a certificate ofCaliforniahigh school proficiency
  4. Received a foreign high school diploma/certificate

COLLEGE GRADUATE:
  1. Received an Associate degree
  2. Received a Bachelor degree of higher

CLASS CODE

CLASS/ACTIVITY: DEPT/COURSE NO/TITLE

CLASS/ACTIVITY DATES(S)

FEE

ANTHR 848AA ANCESTRAL DNAOct. 18th and Nov. 15th

$150.00

Make check payable to: College of Alameda by October 16, 2008

Mail to:           ANCESTRAL DNA WORKSHOP

                        Office of Instruction, College of Alameda

                        555 Atlantic Avenue

                        Alameda, CA 94501