Fillable Application International Student Application

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Application International Student Application

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The Application International Student Application form is 3 pages long and contains:

  • 1 signature
  • 30 check-boxes
  • 74 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Pasadena City College

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Important Note: All Paper Work Requests Have a 10-day Turn-around Period
Revised 3/27/2015 1570 East Colorado Blvd. D-204 • Pasadena, CA 91106-2003 • (626) 585-7808 • FAX (626) 585-3268
In the b
PASADENA CITY COLLEGE
INTERNATIONAL STUDENT APPLICATION
Please TYPE and complete. Handwritten will not be accepted.
Type of Application:
Overseas (Students not in the U.S. without an F-1 visa)
U.S. Transfer (Students currently in the U.S. with an F-1 visa)
Change of Status (Students currently in the U.S. with a visa other than F-1)
Indicate Semester Start Date:
Fall (August 20____)
Spring (January 20____)
Name(as it appears in your passport):
________________________________________________________________________
Family Name First Name Middle Name
Date of Birth ________/_______/_______ Male Female
(Month) (Day) (Year)
Married Single
Country of Birth____________________________________
Country of Citizenship_______________________________
Native Language____________________________________
Will Dependent(s) accompany you to the U.S.? Yes No
If Yes, please submit a copy of your spouse and/or child’s passport
and visa. Please write their country of birth on the copy. For
children, please provide a copy of their birth certificate. For your
spouse, please provide a copy of your marriage certificate.
(Must be in English or have official translation in English).
The bank statement must show an additional $5,000 for your
spouse and $3,000 for each child.
Home Country Address (Required for All Applicants):
Number & Street_____________________________________
__________________________________________________
City_______________________________________________
State/Province_______________________________________
Country ____________________Postal Code______________
Address in the U.S. (Required for Transfer Applicants):
Number & Street_________________________________________
_______________________________________________________
City___________________________________________________
State_________________________ Postal Code_______________
Contact Information (Required for All Applicants):
Email Address_______________________________________
Home Phone________________________________________
Mobile Phone_______________________________________
PASSPORT PHOTO
Important Note: All Paper Work Requests Have a 10-day Turn-around Period
Revised 3/27/2015 1570 East Colorado Blvd. D-204 • Pasadena, CA 91106-2003 • (626) 585-7808 • FAX (626) 585-3268
Visa Information
Where would you like your form I-20/admission documents sent?
Home Country Address U.S. Address Agency Will be picked up by: ______________________
Agency/Advising Center or other mailing address (if applicable)
Agency Name: ____________________________________ Agency Contact Person: _______________________________________
Email: _____________________________________________Phone: ___________________________________________________
Address_____________________________________________________________________________________________________
Number & Street City State/Province Country Postal Code
Important Note: All Paper Work Requests Have a 10-day Turn-around Period
Revised 3/27/2015 1570 East Colorado Blvd. D-204 • Pasadena, CA 91106-2003 • (626) 585-7808 • FAX (626) 585-3268
Highest Level of Education Completed:
Not a high school graduate and not enrolled in school Associate’s Degree from a U.S. college
U.S. high school graduate or will graduate this semester Bachelor’s Degree or higher from a U.S. college
Foreign H.S. graduate or will graduate this semester
Year Completed: ____________________________
In the United States we have a law called the Right to Privacy Act. This means we are unable to discuss your application or acceptance
status with anyone else but you. If you wish to have a person to act on your behalf, please complete the section below:
Name__________________________________________________________________Telephone____________________________
Family Name First Name
Email______________________________________________________________ Preferred Method of Contact Phone Email
Address_____________________________________________________________________________________________________
Number & Street City State/Province Country Postal Code
Relationship to applicant ___________________________Applicant Signature____________________________________________
FERPA Notification: under notification of the Family Educational Rights and Privacy Act, you may, at the time you apply, direct the
College to withhold Release of Directory Information to persons or agencies not covered by special exemptions allowed under
FERPA. Directory Information includes a student’s name city or residence; major field of study; participation in officially recognized
activities and sports; if a member of an athletic team, weight and height; dates of attendance; degrees and awards received and the
most recent previous educational institutions attended by the student. Do you give PCC permission to release your Directory
Information?
Yes No
I certify that all information on this application is correct and I understand that any falsification or withholding of information in
completing this application shall constitute grounds for dismissal. I also understand that once I submit my application, my
documents become property of PCC and I no longer have rights to access them.
Signature of Applicant X Date _______________________
Month/Day/Year
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Application International Student Application

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Completed 1 November 2019

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