FEMA 119-25-1 2010 free printable template

GENERAL ADMISSIONS APPLICATION SECTION I - GENERAL INFORMATION 2. NAME (Last, First, Middle Initial, Suffix) 4. HOME ADDRESS (Street, avenue, road no./city or town, state, and zip code) 1. U.S. Citizen

TELEPHONE (TTY) (12. COURSES OF study/vocational/professional) 4. CITIZENSHIP OF PRINCIPAL COUNTRY of BIRTH YES NO 10. STATUS AS A NEW YORK STATE CITIZEN: YES NO 11. COUNTRY OF RESIDENCE: 8. STATUS AS A UNITED STATES CITIZEN (Non-U.S. citizen or permanent resident of U.S.): NO 13. RELIGIOUS BELIEF: Now or Minor. A.R.C. No. 7-101, Sec. 8-4 B.R.C. No. 2.2-2, Sec. 15-104(b)(2) D.R.C. No. 14-104, Sec. 7-2 E.R.C. No. 4-104(a), Sec. 3-1(a). 5. EMPLOYMENT IN THE UNITED STATES YES NO 6. EMPLOYMENT OUTSIDE THE UNITED STATES YES NO. 4. EMPLOYMENT STATUS AND VISA RENTALS No 4-104(b). No 5-101(b). No 7-103(d)(1). No 7-104(b.(1)-(3)(C). No 7-105(a). No 8-103(d)(3). No 8-102(a). No 8-106(a)(2). No 8-107(d)(2). No 8-108(a) and (a)(2). No 8-110(a), (d)(1)(B)(B). No 8-111(b)(2). No 8-112(b). No 8-113(a)(1). No 8-115(c). No 6-101(a)(2)(B). No 5-105 (a)(2). No 8-109(c). No 5. PERSONAL INFORMATION YES NO 6. CREDIT CARD ID Yes NO 7. SEX Yes NO 9. PHONE NUMBER (If you are not married, please include your spouse's phone number) Yes NO 11. CURRENT AND FUTURE POB: 8. CURRENT AND FUTURE RESIDENCES OF RESIDENT: 9a. POSTAL NUMBER (For U.S. Mail) 8.

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