Student and Parent/Guardian Information Form
Full legal name (as on passport)
*
First, middle, last (family)
Gender
*
Birth date
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
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Day
Please select a year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
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2009
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1931
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1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Permanent e-mail (not school)
*
Primary phone
Alternate phone
Permanent Home Address: House or Apartment Number, Street Name, City, State, Province, Region, Country, and Zip or Postal Code
*
Citizenship(s)
*
Curtis asks all students to submit a copy of the photo page of their passport. Make sure all numbers are visible and clear.
*
Browse Files
If you possess more than one passport, please upload them together as one pdf or jpg file.
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Are you a Permanent Resident (green card holder) of the United States?
*
Yes
No
If you answered "Yes" to the above question, please submit a copy of your Permanent Resident card
Browse Files
Please upload a pdf or jpg file.
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Passport(s) - List country, number and expiration date for all held.
List country, number, and expiration date for all held.
International Students
Will you be applying for an F-1 visa?
Yes
No
If yes, we will contact you about applying for your F-1 visa.
If transferring from another school please type the school's name:
If you are a permanent resident please type your number here:
Parent/Guardian Information
Parent/Guardian 1 name
*
Parent/Guardian 1 e-mail
*
Parent/Guardian 1 phone (include area/country/city codes as applicable)
*
Parent/Guardian 1 address
*
Parent/Guardian 1 phone (include area/country/city codes as applicable)
*
Parent/Guardian 2 name
Parent/Guardian 2 e-mail
Parent/Guardian 2 phone (include area/country/city codes as applicable)
Parent/Guardian 2 phone number (include area/country/city codes as applicable)
*
Parent/Guardian 2 address
Emergency Contact
Name
*
Relationship
*
Phone
*
E-mail
*
Address
*
Street, City, State, Zip, Country
Student Photo
For our internal student directory, please submit a current photo of yourself. This can be any photo you choose, professional or casual, and show your face clearly.
Browse Files
Please upload a png or jpg file.
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Submit
Should be Empty: