PERSONAL HISTORY STATEMENT

INSTRUCTIONS: ANSWER ALL QUESTIONS COMPLETELY IN THE SPACES PROVIDED. DO NOT WRITE IN THE MARGINS. PRINT MOST LEGIBLY. IF A QUESTION DOES NOT APPLY, WRITE "NOT APPLICABLE" OR "N/A". IF YOU NEED MORE SPACE TO ANSWER A QUESTION, USE THE REVERSE SIDE OF THIS SHEET OR AN ATTACHED SHEET OF PAPER. ANSWER ALL QUESTIONS IN THE ORDER IN WHICH THEY ARE ASKED. MAKE SURE THAT ALL INFORMATION IS ACCURATE AND COMPLETE. IF YOU DO NOT KNOW THE ANSWER TO A QUESTION, INDICATE "UNKNOWN". IF YOU DO NOT REMEMBER THE EXACT DATE OF AN EVENT, INDICATE "APPROXIMATE". IF YOU ARE NOT SURE OF THE SPELLING OF A NAME, INDICATE