International Identity Card Application

International Identity Card Application
1. Please print in CAPITAL BLOCK LETTERS Shade circles like this: ●
2. Please use BLACK INK NOT like this: ⊗ or √
3. Please keep your printing inside of the boxes provided
(please see eligibility requirements and questionnaire on reverse)
Which card are you applying for? (use on box only): О Student Ο Teacher
Citizenship
First Name
Last Name
Number and Street Address (U.S. Address Only)
City State Zip Code
Date of Birth
(Area Code) Telephone Number
Month Date
Year
E-mail
School Name
Permanent Address (if different from above)
Number and Street
City State Zip Code
(Area Code) Telephone Number International Identity Card # Date of Issue
I hereby certify that this information is true and
understand that any false statements on my part
may result in the forfeiture of any benefits
associated with the card.
( O V E R )
FOR OFFICE USE ONLY
Signature ________________________________________

You Will Need:
1. Proof of student/youth/teacher status (see below)
2. One Photo (Passport size)
3. I.D. Card Fee $25.00 cash or check
(payable to The College of Staten Island)
Students: Photocopy of school ID (must be validated for current academic year)
Teachers: Photocopy of Faculty ID (must be validated for current academic year)
Note: Some age restrictions may apply on certain student discounts.