Flushing Booking Application Flushing GLF Program Application Student Housing Works Program Application Personal Information First Name Last Name * Gender * Male Female Other Date of Birth * SS# (Tax ID) Country of Residence * Passport Passport Country Current Address * City * State * Postal Code * Phone (day) * Phone (night) Receive text messages about your application? * Yes No Drivers License State Country Email Address * Emergency Contact Name * Relationship to You * Emergency Contact Address * Emergency Contact Telephone Number * Email * Are you a Student? * Yes No School Name * School Address Expected Date of Graduation * Admissions Department Contact Number Are you enrolled in an Internship? * Yes No Internship Program Name Internship Address Expected Date of Completion Supervisor Contact Information (Name and Telephone number) Length of Stay in New York * Primary Purpose of Stay Reason for Enrolling * What are your career goals? What field of study / industry? * Do you wish to enroll in an internship? * Yes No If “Yes” then please specify your desired industry field(s) Have you ever been convicted of a felony or a misdemeanor? * Yes No If “yes” please explain the circumstances: If you are human, leave this field blank. Next
