San Francisco Discover Application

Applicant Information

Personal Information: Enter your name as it appears in your passport:

Family Name *

First Name

Middle Name

Email *

City of Birth *

Country of Birth *

Country of Citizenship

Permanent Home Country Address (Physical address of residency)

Address *

City *

State/Province

Postal Code

Country *

Country Code

Telephone

Education Information

Are you a college or university student? *

Yes

If yes, what is the name of your college or university?

Agency/Organization Information (if any)

Complete section if you are an agent/representative applying on behalf of the applicant.

Agency/Organization Name

Contact Person First Name

Contact Person Last Name

Contact Person Email

Emergency Contact Information

Give information about someone in your home country that can be contacted in case of an emergency.

Family Name *

First Name

Relationship *

Country Code

Telephone

Email *

Does your emergency contact speak English?

Yes

If not, what language(s) does your emergency contact speak?

Signature

Certify *

By clicking here and entering my name below

I certify that I have provided complete and accurate responses to the items on this application.
I understand that any misrepresentation may be cause for denial or cancellation of admission or enrollment.
I understand that admission to the San Francisco Discover program is subject to payment of all fees and tuition and does not imply admission to any other program at SF State.
I agree to purchase the required CSU sponsored health insurance plan. I understand that I will be disenrolled if I do not comply (applies to In-Person program).

First Name *

Last Name *

Date (mm/dd/yy) *

How did you find out about the San Francisco Discover Program?

Please select one:

If other, please specify:

Leave this field blank