NAME: STUDENT ID #: HOME ADDRESS: ZIP CODE: GENDER: MALE FEMALE NON-BINARY X DATE OF BIRTH: CELL PHONE: PERMANENT NUMBER: HOSTOS EMAIL ADDRESS: SECONDARY EMAIL ADDRESS: RACE/ETHNICITY (CHECK ALL THAT APPLY): AFRICAN AMERICAN/BLACK HISPANIC/LATINO WHITE ASIAN NATIVE HAWAIIAN/PACIFIC ISLANDER NATIVE AMERICAN INDIAN/ALASKAN NATIVE OTHER U.S RESIDENCY STATUS: PERMANENT RESIDENT US CITIZEN ADMITTED REFUGEE EDUCATION: CURRENT CLASS LEVEL: 1st YEAR FRESHMAN1st YEAR SENIOR2nd YEAR FRESHMAN2nd YEAR SENIOR GPA: ACADEMIC ADVISOR: MAJOR: EXPECTED DATE OF GRADUATION: SUBMIT APPLICATION & REQUIRED DOCUMENTS TO THE MACSS OFFICE IN ROOM A-126 If the form above does not work for you apply here: