| Today's Date:___________________________________* Social Security Number:______________________ NAME: Last:_______________________________First:_________________________Middle Initial:_______ (Please Print) __________________________________________________________________________ Current Address (Street, City, State, Zip) Current Area Code & Phone CURRENT ADDRESS VALID UNTIL:_______________________________________________________ _________________________________________________________________________________________ Permanent Address (Street, City, State, Zip) Permanent Area Code & Phone *Birthdate:__________________ *Gender:______Female______Male *Veteran_____ Yes _____No *Physically Challenged___Yes___No *CHECK ONE:___U.S. Citizen___Parmanent Resident___StudentVisa *Race/Ethnic Origin:__African-American__Asian Indian__Asian
Pacific__Caucasian__Hispanic *THIS INFORMATION IS FOR REGISTRATION PURPOSES ONLY AND WILL NOT BE RELEASED TO EMPLOYERS. CURRENT GOVERNORS STATE STATUS: Class:_____Junior____Senior____Graduate
Student____Alumnusina____Faculty_____Full-Time Staff If you are currently enrolled as a GSU student, check enrollment status: ___Full-Time___Part-Time___Other Current (or most recent) ____ Arts & Sciences____Business &
Public Administration____Education DEGREE lNFORMATION: Degree currently working on or most recently earned: __Bachelor__Masters__Certificate Graduation Month & Year of above degree: _______________ Major:___________________________________Minor:__________________________________ Cumulative GPA:___________________________Major GPA:_____________________________ OTHER DEGREES EARNED: 1.__Associate__Bachelor__Masters__Doctorate__Certificate__
Graduation Month & Year____________ 2.__Associate__Bachelor__Masters__Doctorate__Certificate__
Graduation Month & Year____________ I hereby authorize the Career-Services staff to use my credential File
and/or resume on my behalf, granting Signature_____________________________________________________Date Signed_______________
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