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    XMGLC 5 RL 0 Iwefocx 015 Bibg 3 Si

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    lisirep402

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    XMGLC 5 RL 0 Iwefocx 015 Bibg 3 Si

    Uploaded by

    lisirep402
    4 views5 pages

    Original Title

    xmglc5rl0iwefocx015bibg3si (3)

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    Copyright:

    © All Rights Reserved
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    Download as docx, pdf, or txt
    4 views5 pages

    XMGLC 5 RL 0 Iwefocx 015 Bibg 3 Si

    Uploaded by

    lisirep402

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 5

    International Student Application

    Application Status
    New Student: A student who is currently living in their home country.

    Transfer Student: A student who is transferring from another U.S. college or university.
    Name of Institution:

    Concurrent Student: A student who will concurrently be enrolled at their U.S. home institution
    and Clark State Community College.
    Name of Home Institution:

    For Admission Beginning (choose one)


    Fall Semester Spring Semester Summer Term
    Academic Year: Preferred Location: Springfield Beavercreek

    Student Name (Must match passport)


    Last (Family Name): First Name: Middle:
    Date of Birth: / /
    mm dd yyyy Gender: Male Female

    Country of Birth: Country of Citizenship: Native Language:


    E-mail: @ Phone: - -

    U.S. Social Security Number (if known): - - Marital Status: Married Single

    Foreign Address and Contact Information (Required)


    House Number: Street Name:
    City: Postal Code:
    District / Province: Country:

    Student United States Address (If currently living in U.S.)


    House Number: Street Name: Apartment Number:
    City: State: Postal Code:
    Major
    (If seeking concurrent enrollment, use major code 8030 for transient studies.)

    Course of Study Code:

    Concurrent Student Only


    What courses are you interested in taking at Clark State?

    Education
    TOEFL Score: Date Taken:

    IELTS Score: Date Taken:

    List all high schools/secondary schools, colleges and universities that you have attended:
    Institution Name:
    City: State: Country:
    Enrollment Years: / Did you receive a degree: Yes No
    Start End

    List all high schools/secondary schools, colleges and universities that you have attended:
    Institution Name:
    City: State: Country:
    Enrollment Years: / Did you receive a degree: Yes No
    Start End

    List all high schools/secondary schools, colleges and universities that you have attended:
    Institution Name:
    City: State: Country:
    Enrollment Years: / Did you receive a degree: Yes No
    Start End

    I-20 Information
    Provide address below where I-20 should be mailed.
    House Number: Street Name:
    City: State / District / Province:
    Postal Code: Country:
    VISA Information
    If you are currently in the U.S., what is your visa type?
    Choose one: F-1 B-1/B-2 H-1 J-1 Other

    If F-1: Have you maintained F-1 status? If not, please explain:

    Have you applied for permanent residence (“green card”)?  Yes No

    Do you plan to travel outside the U.S. before starting your Yes No
    program of study at Clark State Community College?  If yes, when:

    CERTIFICATION STATEMENT
    By submitting this application you certify that the information you have provided on this application is
    complete and accurate to the best of your knowledge. You agree to abide by the rules and regulations of
    Clark State Community College.

    Student’s initials:  Date


    Estimated Expenses

    One academic year of study (two semesters--12 credits per semester)


    Non-resident tuition and fees: $6,300
    Living Expenses: $13,000
    Textbooks and supplies: $1,600
    Summer Expenses: $4,300
    Total: $25,200
    Note: Costs and estimated expenses are subject to change.

    Financial Support

    The total amount of money that I have available for each academic year of study is: $
    The source(s) of my funds (family, personal savings, embassy, government scholarship) is in
    the amount of $ .

    Statement of Financial Support

    The statement below must be completed by a financial sponsor.

    This is to certify that I, (insert full legal name of financial supporter here) will provide sufficient funds
    to cover all expenses of (insert full name of student here) while he/she is enrolled as a student at
    Clark State Community College. I understand that I need to provide proof of funds (at least $25,200)
    per year to cover all educational and living expenses. For your review, I am submitting official
    financial documents showing that I have sufficient funds for this purpose.
    Financial Sponsor Contact Information
    Name:
    Relationship to student: Phone:
    House Number: Street Name:
    City: Postal Code:
    District / Province: Country:
    Signature: Date:

    Notarization/Certification
    Sworn and subscribed before me this __________ of _____________________________, 20______.
    Signature and statement signed and sworn before me: _______________________________________
    Signature of Notary Public, First-Class Magistrate or Bank Official

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