CRIMINAL RECORD RELEASE: The Arbor requires all applicants to disclose the following information and sign the statement of consent:  In accordance with state law, I agree to the School’s conducting a criminal record check in conjunction with my application.

Date of birth:____________________  Place of birth:_________________________________   
Sex   Female  Male

Race: American Indian Asian Black, non-Hispanic  Hispanic  White, non-Hispanic

___________________      ___________________________        _______________________________

Social Security Number                      Driver’s License Number and State                                      Signature Required