Registration Information Sheet
Family Name
For example: Michael Jackson's family name is Jackson.
Your answer
Given Name (No Nickname)
The name on your passport. For example: Michael Jackson's given name is Michael.
Your answer
Street Address
Please give your local address in the United States. If you do not know it or have not yet found housing, please type "None at this time."
Your answer
Apartment
This is the numbers and/or letters on your door.
Your answer
City
Your answer
Zip Code
Your answer
Phone Number
1-123-456-7890 (US Phone Number), if you do not have a US phone number yet, type "NA."
Your answer
Email Address
Your answer
Gender
Date of Birth
MM
/
DD
/
YYYY
Home Country
Your answer
Immigration Status
Additional Information
Is there anything the ELI needs to know before you register today?
Your answer
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