Form

Name (Last, First) *
Email *
Phone
Street address *
City *
State *
Zip *
Workshop choice *
Workshop option *	Non-credit Credit
Birthdate *
Are you a current matriculated IC student?	Yes No
ICID# (if current or former IC student)
Social Security #
Gender	Male Female
Have you registered at Ithaca College before?	Yes No
College(s) attended (institution & highest degree)
Are you a citizen of the United States: *	Yes No
If no, country of citizenship
Type of immigration visa (if applicable
Immigration visa expiration date