Fashioning the Body: Versions of the Citizen, the Self, and the Subject

IMPORTANT: PLEASE READ ALL INSTRUCTIONS CAREFULLY BEFORE FILLING OUT THIS FORM


1.*

FAMILY NAME                                                                    INDIVIDUAL OR FIRST NAME
[_][_][_][_][_][_][_][_][_][_][_][_][_]                         [_][_][_][_][_][_][_][_][_][_][_]

                *PLEASE CONVERT NAMES INTO THE NUMERICAL FORMAT USING THE TABLE BELOW FOR FILING PURPOSES

A	B	C	D	E	F	G	H
01	02	03	04	05	06	07	08
I	J	K	L	M	N	O	P
09	10	11	12	13	14	15	16
Q	R	S	T	U	V	W	X
17	18	19	20	21	22	23	24
Y	Z
25	26

                 >EXAMPLE:        [N][A][N][C][Y]      [S][M][I][T][H]    
 
                                                      WOULD CORRECTLY APPEAR ON FORM AS:
                                                      FAMILY NAME                                INDIVIDUAL OR FIRST NAME
                                                                        [19][13][09][20][08]                   [14][01][14][03][25]
                                                                        

                 PLEASE NOTE: THIS INFORMATION IS BEING GATHERED FOR FILING PURPOSES AND YOU WILL WILL NOT BE INITIALLY MARKED DOWN FOR YOUR RESPONSE TO THIS SECTION
                                                       
2.

GENDER (CHECK ONE)

                 a. MALE [_]          NOT MALE[_]

                 b. IF OTHER PLEASE SPECIFY
                 _______________________________________________________________________________

                 c. HAVE YOU BEEN THIS GENDER CONTINUOUSLY FOR THE LAST SIX MONTHS?  YES [_] NO [_]

                          d. IF NO, FOR HOW MANY MONTHS HAVE YOU BEEN YOUR CURRENT GENDER? [_]
                               (ALSO PLEASE AFFIX A SEPERATE PIECE OF PAPER DESCRIBING YOUR GENDER BEHAVIOR FOR THE LAST 12 MONTHS ALONG WITH A BRIEF JUSTIFICATION AND 2 REFERENCES WHO CAN VOUCH FOR YOU AND WHOM YOU HAVE KNOWN FOR AT LEAST 12 MONTHS)*
                               
                                       *PLEASE NOTE: ALTHOUGH YOUR ANSWERS TO THESE QUESTIONS MAY PUT YOU IN A "SPECIAL GROUP" THIS WILL NOT BAR YOU FROM OUR SELECTION PROCESS, NOR WILL IT IN ANY WAY, SHAPE, OR FORM, CREATE ANY CHANGES IN OUR AFFECT TOWARDS YOU. WE ARE EXTREMELY BENEVOLENT AND CAN TOLERATE MEMBERS OF SPECIAL GROUPS. IT DOES NOT BOTHER US, REALLY. 
                  
3.

GONADAL SEX (CHECK ONE)

                    a.MALE [_]         [_] NOT MALE

                               b. IF NOT MALE, WHY?
                               ____________________________________________________________________________