International Student Application Form

International Student Application Form
STUDENT INFORMATION:
NAME: ______ SEX: FEMALE ___MALE
(First Name) (Middle Name) (Last Name)
U.S. Social Security Number, if you have one:___________________________________
_________________________________________________________________________________________________
Birth date Birthplace Country of Citizenship Country Issuing Passport
(month/ day/ year)
CURRENT ADDRESS: (Print name and address as it should appear on a mailing envelope)
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
NOTICE: If accepted, the I-20 will be sent to the above address
Intended date of departure from above address:__________________________
TELEPHONE NUMBER: ________________________________________________________
EMAIL ADDRESS: ______________________________________________________________
FAMILY INFORMATION:
Are you married? How many children? Will your family accompany you? ___YES ___NO
EDUCATIONAL PLAN:
Semester you wish to enroll (Check one, write year):FALL (August) SPRING (January) SUMMER (June) 20______
If you cannot enroll for the semester indicated above, do you wish to be considered for admission for the following semester?
YES NO Length of time you anticipate studying at HCC: years
Select appropriate classification: Freshman Sophomore
Desired Major:_______________________________________________________
IMMIGRATION INFORMATION: (For Students Applying from INSIDE the
U.S.A. ONLY)
Date you first entered the USA:
Date you last entered the USA:
Type of Visa: ________ Other:______
Your U.S. INS Admission Number?
(From Your Form I-94)
Are you transferring from: a U.S. College/University? YES NO an ESL Program? YES NO
Name of School or Organization who issued your I-20 or IAP-66 form used to enter
the U.S.A.:________________________________________________________
Have you applied or do you plan to apply for U.S. residency or citizenship in the next 12 months? YES NO

HOUSING INFORMATION:
If admitted, will you be interested in living in HCC Dorm Housing? ___YES ___NO
EDUCATIONAL BACKGROUND:
Please provide a complete summary of your educational background, beginning with your initial enrollment in secondary school
and including present enrollment, if applicable. List all colleges and/or universities you have attended. Failure to do so is
considered falsification of records and may result in denial or suspension.
Institutions Years of attendance Certificates, degrees, etc.
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
TOEFL Information:
TOEFL Minimum Score Required: 500 paper based test, 173 computer based test or 61 internet based test.
If you have taken the TOEFL, give the date: ____________, and attach a photocopy of your scores. OFFICIAL results of all
tests taken must be sent directly to HCC from the examining agency before admittance to HCC is complete.
If you have not taken the test, when do you intend to take the TOEFL: ____________.
Have you requested that test results be sent to HCC? ____YES ____NO If yes, please give request date: ____________
FINANCIAL RESOURCE VERIFICATION:
The HCC Financial Resource Verification form, which verifies your sponsor's ability to provide funds, must be attached to your
application. You and your sponsor must also request a verification letter be sent from the sponsor's financial institution
directly to HCC. Applicants failing to provide a completed verification form and verification letter will not be considered for
admission. The HCC Financial Resource Verification form may be printed from the HCC International Student homepage. Please
refer to the costs mentioned in the "Planning for your future" section of this application when completing the HCC Financial
Resource Verification form.
I, the applicant, certify that the information that I have provided in this application is true and accurate to the best of my
knowledge.
____________________________________________________________
Signature of Applicant
_______________________________
Date