Senior Citizen Audit
Application
Student Full Legal Name ___________________________________________________________________________________________
Have you attended USF before? Yes No Former name during attendance, if different: ________________________________
Social Security Number ____ ____ ____ ____ ____ ____ ____ ____
The University of South Florida protects the social security numbers of all individuals which are in its possession. As required by
Florida law (119.071 (5)), USF provides written notice to persons of the potential uses for the number at it.usf.edu/standards/ssn.
Please do not return this form via email.
Term/Year of Registration: Fall ____________ Spring ____________ Summer ____________
Gender ________________ Date of Birth _____________________________
Street Address ___________________________________________________________________________________________________
Email ________________________________________ Telephone ________________________________________________________
Emergency Contact _________________________________________ Emergency Contact Phone ______________________________
Are you a citizen of the United States? Yes No Are you a U.S. permanent resident? Yes No
If no, what is your nation of Citizenship ________________________________________________________________________________
Visa Type, if applicable (check one): F-1 F-2 J1 J2 Other ____________________________________________
Ethnicity (check one): Hispanic or Latino Yes No
Race (check all that apply): American Indian or Alaskan Native Asian Black or African American
Native Hawaiian or Pacific Islander White
Home Campus: Tampa St. Petersburg Sarasota-Manatee
Military Affiliation
Are you currently serving in the U.S. Armed Forces (including the National Guard or Active/Inactive Reserves)? Yes No
Have you ever served in the U.S. Armed Forces (including the National Guard or Active/Inactive Reserves)? Yes No
Are you a spouse or child of a person currently serving in, or who has ever served in, the U.S. Armed Forces (including the National Guard
or Active/Inactive Reserves)? Yes No
Conduct Information
Are you currently or have you ever been charged with or subject to disciplinary action for scholastic integrity violations (such as plagiarism
or cheating) or any other type of behavioral misconduct (such as violations of a student conduct code) at any educational institution?
Note: “Yes” is not required for poor academic performance unrelated to academic integrity violations or behavioral misconduct.
Yes No
Have you ever been charged with a misdemeanor and/or felony?
Note: You must respond “Yes” for criminal records that (1) have not received a final expungement order; (2) have been sealed or are in
the process of being sealed; (3) misdemeanor or filing actions that are pending.
“Yes” is not required for (1) traffic violations that resulted in a fine only; (2) violations below the misdemeanor/felony level; or (3) charges or
convictions that have been expunged by final order.
Yes No
