City College of San Francisco Application Form for Admission

CITY COLLEGE OF SAN FRANCISCO
APPLICATION FOR ADMISSION
C R E D I T D I V I S I O N
APPLICATION DATE
OFFICE OF ADMISSIONS & RECORDS • 50 PHELAN AVE. • ROOM E-107 • SAN FRANCISCO, CA 94112 • (415) 239-3285
Please provide ALL information requested on this form.
PERSONAL INFORMATION
1. Social Security Number ______ ______ ______-______ ______-______ ______ ______ ______
Be sure your Social Security Number is accurate as it is used as part of your permanent record. You will also be assigned a Student Identification Number.
2. Legal Name (Please Print)
Last Name _____________________________ First Name __________________________ Middle Name _________________
E-mail Address ______________________________________________________________________________________________
3. Previous Last Name Used at City College if Different From Current Last Name __________________________________
Previous First Name______________________________________ Previous Middle Name _______________________________
4. Term For Which You Are Applying q Fall q Spring q Summer Year ___________________________________
PERMANENT RESIDENCE ADDRESS (NOT A P.O. BOX)
5. Number and Street________________________________________________________________ Apt. Number ______________
City _________________________________________
State ______________________ Zip Code __________________________
Permanent Residence Phone (______) __________________________
Work Phone (______) ___________________________
MAILING ADDRESS (IF DIFFERENT FROM PERMANENT ADDRESS)
6. Number and Street________________________________________________________________ Apt. Number ______________
City _________________________________________
State ______________________ Zip Code __________________________
Permanent Residence Phone (______) __________________________
Work Phone (______) ___________________________
7. Gender q Male q Female q Option Not Listed 8. Date of Birth Month Day Year
___ ___ ___ ___ ___ ___
9. Ethnic Background (check one or more)
Are you Hispanic or Latino? q Yes q No
q 01 Hispanic, Latino
q 02 Mexican, Mexican-American, Chicano
q 03 Central American
q 04 South American
q 05 Hispanic Other
q 06 Asian Indian
q 07 Asian Chinese
q 08 Asian Japanese
q 09 Asian Korean
q 10 Asian Laotian
q 11 Asian Cambodian
q 12 Asian Vietnamese
q 13 Filipino
q 14 Asian Other
q 15 Black or African American
q 16 American Indian/Alaskan Native
q 17 Pacific Islander Guamanian
q 18 Pacific Islander Hawaiian
q 19 Pacific Islander Samoan
q 20 Pacific Islander Other
q 21 White
10.
Citizenship Status? (Check One Only)
q I am a U.S. Citizen (1)
Non-U.S. Citizen
q I am a permanent Resident Alien
Card Holder _____________(2)
q I am a Temporary Resident (3)
q I am a Refugee/Asylee (4)
q I am on a Student Visa (M-1 or F-1) __________ (5)
q Other Citizen Status ________________________ (6)
q I am a recipient of a B1, B2, or F2 Visa __________ (9)
Example 1 2 2 5 6 7
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City College of San Francisco Application Form for Admission PDF

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