EL CAMINO COLLEGE
International
Concurrent Enrollment Application
CHOOSE A SEMESTER:
(For students already inside the US)
PLEASE PRINT OR TYPE IN BLACK OR BLUE INK
PERSONAL INFORMATION
Male Female
Last (Family or Surname) First (Given) Middle name
Local Address in the United States Address in your Country (Required)
(Address where the acceptance letter should be mailed) (NO P.O. Boxes, no Agency Addresses, Please)
City City Postal Code
State Postal Code (ZIP) Province/State Country
Telephone Number Telephone Number (required)
Email (required)
Birthday Birth Citizens
hip Ethnicity____________________
Month / Day / Year (Country) (Country) (Optional)
Do you have dependents? Yes No
Name of spouse/dependents accompanying you to the US [Include full name(s), date(s) of birth, country(-ies) of birth]
IMMIGRATION INFORMATION
When did you enter the United States? _______________ Visa Type_______________ Expiration Date__________________
Month/Day/Year Month / Day / Year
EDUCATION INFORMATION
List all the language and high schools, colleges and universities attended:
High Schools Graduation Date
College Dates Attended
Last College/University Dates Attended
Language School Dates Attended
FIELD OF STUDY (required) _______________________________________________ (Please do not write “Undecided”)
Student Expenses
Office Use Only: Fed-Ex Tracking #_______________________________________ Date: __________________________________
El Camino College Student ID Number _______________ SS Number____________________ SEVIS ID_ N____________________
Major Code: _ _ _ _ Admit Status: 1 2 3 4 5 CU Enter by: _____________________ Date: _____________________
Passport-
Sized Photo
FALL
SPRING
SUMMER WINTER
SEVIS ID# N_____________________ Current School in the US_______________________
I hereby certify that, to the best of my knowledge, all information furnished on this form is complete and accurate. I further understand that the falsification of information
can lead to immediate dismissal from El Camino College. El Camino Community College District ensures equal access to its services, classes and programs without regard to
race, religious creed, sex/gender, national origin, handicap or services as a veteran.
Date Signature____________________________________________________
How Did You Learn About El Camino College?
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signature
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