New Americans Data Form  (all fields are required )
First Name:
Last Name:
Email Address:
Phone#:
Do you have a CUNY EMPL ID?	Yes No
Do you have an Alien Registration Number (A# or USCIS#)?:	Yes No
Country of Origin:
Date of Birth:
Gender:
NYC Borough or County:	Select Bronx Brooklyn Manhattan Queens Staten Island Other   Specify Other:
Do you receive any means tested public benefit?:	Select None Medicaid Snap/Food Stamps SSI Section 8 Cash Assistance Other   Specify Other: