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Chong Shin University in U.S.A. School of Theology / School of Church Music APPLICATION FOR ADMISSION > Read all statements carefully. Complete entire form. Print Clearly. Print Name Maiden or Former ECC Name Birth Date Ethnic & Racial Survey (Optional) To determine accurately institutional compliance with the Federal Rights Act of 1964, e Department of Health, Education and Welfare requires to have each enrolling student provide the following data. Please Check Only One: Social Security No. Spring 20_ _ Summer 20_ _ Fall 20_ _ Winter 20_ _ Male A. American Indian or Alaskan Native B. Asian: Country C. Black (not of Hispanic, Origin) D. White (not of Hispanic, Origin) E. Hispanic F. Philippians G. Pacific Islander H. Other I. Unknown X. Decline to State Female Driver’s License No. Current Address If unmarried and under 18, Give information of Parent you resided with Last name of parent or court-appointed Guardian City Daytime Phone Cell State Zip Age Gender (Last) (Month) (Day) (Year) (Month) (Day) (Year) (First) (Middle) ( ) - ( ) - Current Address English is the language I speak most often When did you present stay in America begin? Are you a U.S. Citizen? OFFICE USE ONLY (Month) (Day) (Year) When did you present stay in California begin? I expect to work hours each week this semester City Daytime Phone Cell State Zip ( ) - ( ) - Yes No Yes No (Do not write a P.O. Box in this space.) (Do not write a P.O. Box in this space.) - -
