8/2011
Form A
PRELIMIARY APPLICATION FOR FOREIGN STUDENT ADMISSION
The official language of this college is English and all forms and correspondence must be completed in English.
PLEASE PRINT OR TYPE ALL INFORMATION
Date__________________________________
Full Name: _________________________________________________________________________________________________
Last First Middle Maiden
Mailing Address: ____________________________________________________________________________________________
Date of Birth: _____________/____________/__________________
Month Day Year
Age: ______ Sex: Male Female Race: _______________________
Marital Status: Married Single Divorced Widowed Other
I plan to bring the following dependents with me. List and specify relationship to you.
Name
Relationship
Age
Secondary High School Attended
Name of School
Country
Year Graduated
College(s) Attended
Name of School
Country
Year and Date
Language of instruction used at the college(s) (i.e. English, French, etc.) ________________________________
Circle highest year of completion: 6 7 8 9 10 11 12 13 14 15 16 17
Name and address of the person(s) most closely related to you in the Fayetteville area. If you do not have a relative in North Carolina,
give name and address of your closest relative in the United States.
Name
Address
TOEFL test scores: ____________
Religion: __________________________ Your native language: __________________________________
Please check the appropriate box(es) where the English language is used in your environment.
Family School Friends Work Reading TV Movies Community
Print Name: __________________________________________
Applicant’s Signature: ____________________________________________ Dated: ________________________
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