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INTERNATIONAL STUDENT APPLICATION

PERSONAL INFORMATION
Given (First) Name: Middle Name(s)
Last(Family)Name
Country of Residence Nationality
Gender Date of Birth:
Country of Birth Country of Citizenship
MAILING ADDRESS
Street Number & Name Apartment Number
City State
Postal/Zip Code Country
Email
Primary Phone Number Secondary Phone Number
PERMANENT ADDRESS IN HOME COUNTRY
Street Number & Name Apartment Number
City Province
Postal/Zip Code Country
Email
Primary Phone Number Secondary Phone Number
EMERGENCY CONTACT
Last (Family) Name: Given (First) Name
Relationship Language Spoken
Street Number & Name Apartment Number
City State
Postal/Zip Code Email
Home Phone Number Alternative Phone Number
HOW DID YOU HEAR ABOUT US ?
Yahoo Our Website Embassy/Consulate Relative/Friend
Google Yellow Pages Student Other

If from a student, please specify the name.

ADDITIONAL INFORMATION
Last Arrival into US I-94 #
Current Visa Status Visa Expiration
Passport Number
(if applicable)		 Passport Expiration
DOCUMENTS
REQUIRED DOCUMENTS (check all that apply)
Copy I-94 Copy I-66 (if any) Current I-20 (if any)
Affidavit of Support Copy of Passport Copy of DS-2019
PROGRAM OF STUDY
Computer Information Systems 1 year 2 year Prefered
Start Date
Management 1 year 2 Year Prefered
Start Date