CSUN ID Number or last 4 digits of US Social Security Number (if available) ___________________________________Name as it appears on Passport _____________________________________ _______________________________ (Family Name or Surname) (First Name or Given Name) Date of Birth (Month Day, Year) _________________________ Gender: Female ________ or Male _____ ___ Country of BIRTH __________________________ Country of CITIZENSHIP ____________________________ If you are currently in the United States, what type of visa do you hold? (For example, F1, F2, B1, J1, A2, etc.) ______Citizenship Gender: Female ____ Male ______
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