Fillable Form 1: Butte College (Butte College)

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Form 1: Butte College (Butte College)

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Country of origin: US
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1
Butte College
International Student Application____________________________
Please type in your information, print, sign, and submit.
Applicant Information
Applicant Address
Language Proficiency
(Check all that apply)
English is my country’s primary/ official language.
I have completed one of the following Language Proficiency Tests. (Must submit proof of scores)
TOEFL IELTS EIKIN GTEC CBT
I have attended U.S. College/University, High School, or English Program. (Must submit letter of completion or transcript)
ALCI KAPLAN ELS
2+ years in US high School English U.S. College/ University Transfer Level English
NAME: ____________________________________________________________________________________________________________________________
LAST (FAMILY) FIRST: (GIVEN) MIDDLE
PREFERED NAME:________________________________ DATE OF BIRTH: _____________________
MALE
FEMALE
(Optional) (month/ day/ year)
COUNTRY OF BIRTH: ______________________ COUNTRY OF CITIZENSHIP:_________________________________
PRIMARY LANGUAGE: _____________________ E-MAIL:____________________________________________________
(Check your e-mail regularly)
MAJOR: ____________________________________________ EDUCATIONAL GOALS: ______________________________________________
TERM APPLYING FOR: FALL 20 ______ SPRING 20 ______
HOME COUNTRY – PERMENANT DDRESS U.S. CURRENT ADDRESS (If available)
__________________________________________________ ______________________________________________________
NUMBER & STREET NUMBER & STREET
__________________________________________________ ______________________________________________________
CITY CITY STATE POSTAL CODE
__________________________________________________ ______________________________________________________
STATE/PROVINCE/PREFECTURE CELL OR TELEPHONE NUMBER
__________________________________________
COUNTRY POSTAL CODE
For office use only
Student ID # ___________________
[Select One]
[Select One]
2
Butte College
How Did You Hear About Butte College? (Check all that apply)
A Friend or Family Member Your Own Research
Referred by Your Current School Butte Website
I Attended an Educational Fair: City ____________ Educational Agent/Advisor_______________________
Study in the USA Other:_________________________________________
Emergency Contact Information
Release of Information
Social Media (Optional)
Certification
I certify that all statements on this form are true and complete.
________________________________________ ________________________________
Applicant Signature Date (month/ day/ year)
outside agency, institution, or person. Please sign below to authorize the release of your information.
________________________________________ ________________________________
We would like to connect with you through social media. You can either add us on Facebook or provide your social media so that we add you.
1) Our Facebook URL is https://www.facebook.com/dash.butte
2) If you want us to add you, then please provide one of the following:
a. Facebook URL_________________________________________________________
b. Instagram ____________________________________________________________
c. Other________________________________________________________________
DISCLAIMER: This will neither affect your admission nor be used to evaluate your application. It is another way to connect with you and share the
fun activities that the international students do during the semester.
This information will remain on file for the duration of your enrollment. If a change occurs, please report it to Rachel Wood in
the Welcome Center immediately.
Emergency Contact Person: _________________________________________________________________________
Address: _________________________________________________________________________________________
Home Phone Number: _____________________________ Cell Phone Number: ____________________________
E-mail:__________________________________________ Relationship to Applicant: _______________________
Does this person speak English? Yes No
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Form 1: Butte College (Butte College)

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Completed 25 July 2020

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