Ethnic identity/ origin
Enter appropriate code in box (optional). D
1 - American Indian
or
Alaskan native;
tribe
------------------
2 - Black, non-Hispnaic, including African-American
3
- Mexican-American, Mexican, Chicano
A
- Central American
B
- South American
Q-
Cuban
P - Puerto Rican
4 -
Other
C - Chinese
J
- Japanese
K
- Korean
5
-
Other
Asian
M
- Cambodian
L - Laotian
V - Vietnamese
T
-
Thai
S -
Other
Southeast Asian
G
- Guamanian
H
- Hawaiian
N - Samoan
7
- White
8 -
Other
______________
_
9
-
No
Response
D
- Decline to State
If
you have a physical, perceptual, psychological
or
learning disability, enter a
Yin
the box (optional). D
Do
you have the interest
and
ability to participate
in
NCAA-sanctioned intercollegiate athletics competition
(optional)?
Yes
0
No
0
If
yes, you should contact the campus
Department
of
Athletics to register your interest
in
a sport
or sports.
Is
either parent a
CSU
graduate (optional)?
Yes
0
No
0
If
yes,
which campus?
____________
_
What
are your parent's highest level
of
formal education
(optional)?
Enter code
in
box for Mother D
and
Father D
I
-
No
High
School
2
-
Some High School
3 -
High School Graduate
4
-
Some College
5
-
2-Year College Graduate
6
-
4-Year College Graduate
7 -
Postgraduate
Certification-to be read and signed
by
all
applicants
to
certify the accuracy
of
the
information provided.
I certify under penalty
of
perjury,
or
after first being duly sworn, that I have provided complete
and
accurate re-
sponses
to
the items
on
this application. I further certify (swear) all official documents submitted
in
support
of
this
application are authentic and unaltered records that pertain to me. I authorize release
of
any
information submitted
by me in connection with
my
application
to
any person, firm, corporation, association
or
government agency,
but
only
to
verify or explain the information, obtain pertinent records, or in connection with perjury proceedings.
My
signature certifies the accuracy
and
completeness
of
the information provided. I understand that
any
misrepresenta-
tion may be cause for denial
of
cancellation
of
admission or enrollment.
I certify (swear) that so long
as
I
am
a student
at
this institution, I will advise the residence clerk
if
there is a change
in any
of
the facts affecting
my
residence.
I agree
to
meet the California State University comprehensive health insurance requirement for the duration
of
studies/practical training
as
listed
on
my 1-20 or DS-2019 form.
Signed at
City
and
County
Applicant's Signature Date
Nondiscrimination
Policy--
The
California State University does
not
discriminate
on
the basis
of
race, color, na-
tional origin, sex, physical handicap
or
sexual orientation in the educational programs
or
activities
it
conducts.
