General Admissions Application Short FormGeneral Admissions Application Short Form
Download the document to the computer for easy use
There are more pages to preview,Read on

DEPARTMENT OF HOMELAND SECURITY

O.M.B. No. 1660-0100
Expires May 31, 2010

See Reverse for
Privacy Act Statement

FEDERAL EMERGENCY MANAGEMENT AGENCY

GENERAL ADMISSIONS APPLICATION SHORT FORM

USE THIS FORM ONLY IF APPLYING FOR NFA OFF CAMPUS COURSES (EXCLUDING REGIONAL DELIVERIES)
SECTION I - GENERAL INFORMATION
1. DATE OF BIRTH (Mo, Day, Yr.)

2. SEX
FEMALE

4a. ETHNICITY
HISPANIC or LATINO
1.
2.

MALE

3. U.S. CITIZEN

4b. RACE (Please check all that apply)
AMERICAN INDIAN or ALASKA NATIVE
1.

NOT HISPANIC or LATINO

4.

WHITE

YES

NO

2.

ASIAN

5.

NATIVE HAWAIIAN or PACIFIC ISLANDER

If No, City and Country of Birth:
BLACK or AFRICAN AMERICAN

3.

5. PLEASE PRINT YOUR NAME (Last, First, Middle, Suffix)

6. SOCIAL SECURITY NO.

7. MAILING ADDRESS (Street, avenue, road no./city or town, and zip code)

8. WORK PHONE NO. (

)

9. HOME PHONE NO. (

)

10. FAX NO. (

)

11. E-MAIL ADDRESS
12a. ENTER COURSE CODE AND TITLE

12b. COURSE LOCATION

12c. DATE

13. DO YOU HAVE ANY DISABILI