Parsons Blvd. Flushing Application GLOBAL LEADERSHIP FOUNDATION 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 * Emergency contact 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: Next
