NUBA MOUNTAINS
INTERNATIONAL ASSOCIATION - USA
"Unity–Empowerment–Development–Peace"

رابطة جبال النوبة العالمية
الولايات المتحدة الأمريكية
الوحدة – التمكين – التنمية – السلام

2026 – GENERAL CENSUS FORM

for Nuba People in United States

SECTION 1: PERSONAL INFORMATION

Full Name *

Gender

MaleFemale

Date of Birth *

Marital Status

MarriedSingleWidowedDivorced

Phone Number *

If Married, Spouse's Full Name

Email *

Residential Address *

City, State, Zip Code *

SECTION 2: FAMILY AND HOUSEHOLD INFORMATION

Dependents(between 1 – 25)

Full Name	Infants – 1–7		Teenagers – 8–14		Youths – 15–25		Adults – 26 & Plus
Full Name	Male	Female	Male	Female	Male	Female	Male	Female
	✓	✓	✓	✓	✓	✓	✓	✓
	✓	✓	✓	✓	✓	✓	✓	✓
	✓	✓	✓	✓	✓	✓	✓	✓
	✓	✓	✓	✓	✓	✓	✓	✓
	✓	✓	✓	✓	✓	✓	✓	✓
	✓	✓	✓	✓	✓	✓	✓	✓

Field of Study / Profession

Hobbies / Talents

Immigration Status

U.S. CitizenRefugeeAsylee

Others:

Year Arrived in United States

Country of First Asylum

First State of Residence in USA

SECTION 3: PLACE OF ORIGIN (HOMELAND)

State of Origin

South Kordofan/Nuba Mountains

Others:

County / District

Home Village / Town

Tribal / Ethnic Group

Language & Religion

List Spoken Languages

SECTION 5: CONSENT & DECLARATION

Signature (Type Full Name) *

Date *

SECTION 6: FOR OFFICE USE ONLY

Census Enumerator Name

Date Collected

State Chapter

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