Cal Poly – Student Information Please provide the following information: General InformationPlease indicate which Program you are participating in.* Cal Poly University Architecture Cal Poly University Mechanical Engineering Cal Poly University Software Engineering Name First Last Permanent Street Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home PhoneCell PhoneEmail Gender Female Male This info is necessary for housing assignments. For other genders please contact AIA.Date of Birth MM slash DD slash YYYY Passport InformationName as it appears on passport (i.e. including middle names)CitizenshipPassport NumberPlace of Issue (city, country)Place of Birth (city, state and country)Date of IssueDate of ExpirationUnisex T-Shirt SizePlease SelectWomen's SmallWomen's MediumWomen's LargeWomen's X-LargeMen's SmallMen's MediumMen's LargeMen's X-LargeFor information on how to calculate your Unisex t-shirt size please see https://www.thewrightbrothersusa.com/pages/t-shirt-sizing-chartEmergency Contact InformationPlease supply two people whom we should contact in the event of an emergency.Contact OneName First Last RelationshipHome PhoneCell PhoneEmail Contact TwoName First Last RelationshipHome PhoneCell PhoneEmail Medical InformationVOLUNTARY - for Emergencies only. Medical info will not impact eligibility for enrollment.You may add any medical information you think is relevant - consider what would help us accommodate special needs (i.e. difficulty walking, need for specific treatment, etc.). This space is provided for confidential, voluntary information and will not impact enrollment - you may also offer additional info after arrival.Please let us know if you have a food allergies (i.e. nut allergy, seafood allergy, etc.) or have dietary preferences (i.e. vegan, vegetarian, pescatarian, kosher or halal, etc.) This information is very important as we will book group dinners and inform restaurants of your preference in advance. If you do not provide this information, accommodations cannot be guaranteed.Language ExperienceWe would like to know about your experience with Italian.I have taken Italian language courses in (choose one): High School University I have never taken Italian I took Italian courses for:I would describe my Italian language skills as:Extra InformationPlease add below anything else you feel you should communicate to AIA. Δ
