Student Information_2024 Spring_International Students

For administrative, statistical and emergency contact purposes, please complete this personal information collection form for Georgia Tech - Shenzhen 2024 Spring Semester. Your personal data will be accessed only by our employees or contractors who are authorized to do so.
This form is for international students from countries or regions outside China.

1. Last Name (Must be exactly the same as on your passport.)

2. First Name (Must be exactly the same as on your passport.)

3. GTID (Example: 90xxxxx16)

4. GTSI Major

Computer Science
Electrical and Computer Engineering
Environmental Engineering
Analytics
Industrial Design

5. E-mail (Please provide Georgia Tech email address if you have one.)

6. Phone Number (Please include area code.)

7. Gender

Male
Female

8. Date of Birth

<div>8. Date of Birth</div>
	Month	Day	Year



Please Select:	Month - Please Select:	Day - Please Select:	Year - Please Select:

9. Place of Birth

10. Nationality

11. Religion (Optional)

12. Mailing Address

Specific Address

ZIP/Postal Code (Optional)

City

State/Region

Country

13. Passport

Passport Number

Expiry Date

14. Chinese Visa (If you have)

Visa Number

Visa Categories

15. Undergraduate Education

Institute Name

Major

Graduation Year & Month (yyyy-mm)

16. Emergency Contact #1

Name

Relationship

Phone Number

Address

Email (Optional)

17. Emergency Contact #2

Name

Relationship

Phone Number

Address

Email (Optional)

18. Passport Information Page
(A photocopy of passport data page and photo page. Any words and numbers on the document should be clear and readable.)

19. Visa Page (If you have)
(A photocopy of passport data page and photo page. Any words and numbers on the document should be clear and readable.)

20. Passport Photo
(A recently-taken color passport photo of you, no hat wearing, show full face with ears, against a light color background. JPG format.)