Fillable Green River College - International Programs Student Application

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Green River College - International Programs Student Application

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  • 118 check-boxes
  • 86 other fields

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File type: PDF

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INTERNATIONAL PROGRAMS
INTERNATIONAL STUDENT APPLICATION
12401 SE 320th Street, Auburn, WA 98092, USA • 253-288-3300 • greenriver.edu/international
Green River College is an equal opportunity educator and employer. Learn more at www.greenriver.edu/accessibility.
IP1801Applic
COLLEGE
t--
PLEASE SUBMIT YOUR
APPLICATION TO:
International Programs
Green River College
12401 SE 320th Street
Auburn, WA 98092-3622 U.S.A.
Fax: 1 - (253) 333-4940
Email: international@greenriver.edu
Apply online: greenriver.edu/international
Phone: 1 - (253) 288-3300
E Brochure:
i-studentglobal.com/usa/wa/grc/welcome
IP Blog:
greenriver.edu/international/follow-us.htm
facebook.com/grcciis
youtube.com/user/greenriverintlprgms
twitter.com/grccip
For Green River office use only:
84492- Received:
APPLICATION CHECKLIST:
q Applicant must be at least 16 years of age by program start date.
❏ Completed application
❏ Financial statement – Official bank letterhead in English showing enough funds for
one year of study at Green River (see website for current amount).
❏ $50 non-refundable application fee
❏ Housing choice (16-year-old students are required to live with a Host Family until
they turn 17 years of age).
❏
$300
Housing placement fee
❏ Copy of passport
❏ Transcript from last school attended, sealed by school (highly recommended)
❏ For transfer students only: Transfer-In Form (available by request or on website),
copies of current visa and I-20 and transcripts.
PERSONAL INFORMATION
q New student q Transfer student q Returning Green River student
Last name (family, as it appears on passport):
Date of birth:
month
/
day
/
year
q Male q Female
First name (given, as it appears on passport):
Middle name(s), if any:
Country of birth: Citizenship:
Native language: English ability: q Fluent q Average q Poor
Visa type: q F-1 student q M-1 student q J-1 student q Other
Which of the following best describes you: q No children q Married with children
Do you have any medical conditions or allergies? q No q Yes, describe:
Do you require any special physical or learning assistance? q No q Yes, describe:
How did you hear about Green River College?
q Web search ❏ Green River College website ❏ "Study in the USA” website
❏ Social media ❏ Study Abroad Fair ❏
Friend, relative or current Green River student
❏ Other
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INTERNATIONAL PROGRAMS
INTERNATIONAL STUDENT APPLICATION
12401 SE 320th Street, Auburn, WA 98092, USA • 253-288-3300 • greenriver.edu/international
Green River College is an equal opportunity educator and employer. Learn more at www.greenriver.edu/accessibility.
IP1801Applic
CONTACT INFORMATION:
Student:
Home country address:
Current address:
Phone:
Email:
Emergency contact:
Parent’s names (Last/family, First):
Mother:
Father:
Current address:
Phone:
Email:
Emergency contact phone:
Agency Name:
Where would you like your I-20 sent?
❏ Home country address ❏ Current address ❏ Agency/Advising center (provide address) ❏ Other (provide address)
Agency/Advising center or other mailing address (if applicable)
Agency Name: Agency contact person:
Address:
Phone: Fax: Email:
FINANCIAL INFORMATION:
How will you pay for your tuition and living expenses?
❏ Personal funds ❏ Family funds
❏ Company sponsorship from home country
❏ Government sponsorship from home country
❏ Sponsor within the U.S. (I-34 required) ❏ Other
❏ I am including the following payments with this application (check all that apply):
❏ $50 Application fee is enclosed (non-refundable)
❏ $300 Housing placement fee is enclosed (refundable upon request up to two weeks before move-in day)
❏ Payment by credit card: ❏ Visa ❏ MasterCard Name as it appears on the card:
Card number: Expiration date:
Cardholder relationship to student:
Total charge amount (select one only):
❏ $50 (Application fee only) ❏ $300 (Housing placement fee only) ❏ $350 (Application and housing placement fee)
Signature of cardholder:
❏ Payment by bank wire transfer to: U.S. Bank, 401-15th Street NE, Auburn, WA 98071
ABA No. 125000105
Student Name (must be included with wire information)
Green River Student ID Number (if known)
Green River College
International Account No. 153504623387
SWIFT code: USBKUS44IMT
Important! Send an e-mail to international@greenriver.edu with student name, date of birth, amount of money and date wired.
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EDUCATION:
How much schooling have you had prior to attending Green River College?
❏ No high school diploma (11) ❏ High school diploma (13), month and year of graduation:
❏ Associate degree (16) ❏ Bachelor’s degree or above (17)
Name of school you are currently attending or school last attended:
TOEFL score: Date: IELTS score: Date:
INTERNATIONAL PROGRAMS
INTERNATIONAL STUDENT APPLICATION
12401 SE 320th Street, Auburn, WA 98092, USA • 253-288-3300 • greenriver.edu/international
Green River College is an equal opportunity educator and employer. Learn more at www.greenriver.edu/accessibility.
IP1801Applic
When would you like to start at Green River College?
COLLEGE
INTERNATIONAL PROGRAMS
INTERNATIONAL STUDENT APPLICATION
12401 SE 320th Street, Auburn, WA 98092, USA • 253-288-3300 • greenriver.edu/international
Fall/Sept. ❏❏ Winter/Jan. ❏ Spring/March ❏ Summer/June Year:
What will you study? Check all programs that relate to your studies at Green River College.
You may check more than one box.
❏ University Transfer ❏ Intensive English (IEP) ❏ High School Completion Plus
❏ Associate Degree ❏ Certificate ❏ Special program, which one?
What subject (major) do you plan to study?
Approximately how long will you attend Green River College?
❏ One quarter (11) ❏ Two quarters (12) ❏ One year (13) ❏ Two years (14) ❏ To complete a degree (15) ❏ Don’t know (16)
University Transfer Pathways:
A letter of admission to a 4-year university may be requested at the same time you apply
for Green River College. Go to greenriver.edu/international/university-transfer-pathway for the most recent list of UTP universities.
❏ Yes – I request a UTP letter of admission to:
Please fill in name of UTP university
HOUSING
❏ I will find my own housing (provide your U.S. address if known):
IP Housing requires 16-year-old students to live in a vetted and approved host family for the period of 1 quarter at a time until they turn
17 years of age. Housing placements for 16-year-old students will be given first priority for host family placement.
Housing placements for students 17 years old or older are made in the order completed applications and placement fees are received.
Preferences are met based on availability.
Green River has two housing choices for new applicants, Campus Corner Apartments or Homestay. What is your preference?
Choice #1:
Choice #2:
HOMESTAY APPLICANTS COMPLETE THIS SECTION
This information will be provided to your prospective Host Family.
What type of family do you prefer? (You may check more than one box.)
❏ Family without children ❏ Family with international students ❏ Family with small children ❏ Family with teenagers
Are there foods you cannot or will not eat? ❏ Yes ❏ No What foods?
Do you smoke? ❏ Yes ❏ No ❏ Sometimes
Do you have any religious requirements or preferences?
CAMPUS CORNER APARTMENT APPLICANTS COMPLETE THIS SECTION
This information will be provided to CCA. Placements are made first-come, first-served. Preferences are met based on availability.
I prefer: ❏ Females only ❏ Males only ❏ No Preference
I prefer to share with: ❏ International students ❏ Domestic (American) students ❏ Both
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INTERNATIONAL PROGRAMS
INTERNATIONAL STUDENT APPLICATION
12401 SE 320th Street, Auburn, WA 98092, USA • 253-288-3300 • greenriver.edu/international
COLLEGE
Green River College is an equal opportunity educator and employer. Learn more at www.greenriver.edu/accessibility.
IP1801Applic
/ /
/ /
COLLEGE
INTERNATIONAL PROGRAMS
INTERNATIONAL STUDENT APPLICATION
12401 SE 320th Street, Auburn, WA 98092, USA • 253-288-3300 • greenriver.edu/international
SIGNATURE PAGE FOR PARENTS AND STUDENTS
International Student Admission Policy
New students who use Green River’s I-20 to enter the U.S.A. must: Report in person to Green River’s orientation session for new
international students; Enroll for and attend the first quarter at Green River; Carry Health Insurance while enrolled at Green River; Present
originals of: passport, visa, and Green River’s I-20 - Students transferring from other U.S. schools must present their most recent I-20.
Medical Release
The undersigned hereby gives to Green River College, its officers, employees, agents, and host families full authority and permission
to take whatever action they feel is reasonably warranted under the circumstances, and to act as agent of the undersigned student and
parent/guardian, regarding the named student’s health and safety. This authority and permission includes, but is not necessarily limited
to, the following: Rendering or ordering medical treatment; the giving of medication; and any examinations, X-rays, anesthetic, medical
or surgical diagnosis or treatment or hospital care, if and as deemed necessary. The undersigned understands that a reasonable attempt
will be made to contact the undersigned parent/guardian before any action is taken. The undersigned agrees to be financially responsible
for all medical attention so authorized or ordered during the student’s attendance at Green River College. The undersigned represents
that the named student has no medical restriction that limits his/her full participation in the programs and activities of Green River
College, except as disclosed in any writing attached to this document. Permission is given for the student to participate in all activities
offered at Green River College, except as restricted in any attached writing. To the fullest extent permitted by law, the undersigned hereby
releases Green River College, its officers, employees, agents, and host families from all liability, and waive and release all claims, related
to or arising from such decisions or actions as may be taken under the authority of this document.
Photograph/Image Release
I consent to each use by Green River, and its officers, employees, and agents, of any photograph and likeness of me. Such use
may include, but aren’t limited to, use in a program, catalogue, schedule, newspaper, web site, brochure, advertisement, or other
publication or recording that describes, portrays, publicizes, or advertises the college or any college operation, and every reproduction,
republication, or other re-use of the same. I also hereby waive any right to compensation for such uses, and any right to inspect
or approve the uses beforehand. I hereby release Green River, its legal representatives and all persons acting under its permission
or authority, from any liability by virtue of any blurring, distortion, alteration, optical illusion, or use in composition form, whether
intentional or otherwise, that may occur or be produced in taking of said image.
By my signature below (Please check the following boxes):
❏ I verify that, to the best of my knowledge, all of the statements on this application form are true. I have read and agree to the
published International Student Admission Policies.
❏ I authorize Green River College to release academic records and immigration status information to my sponsor,
educational agency and or parents.
❏ I consent to use by Green River any likeness, image or photo of me for any official college program.
❏ I am either 16 or 17 years of age and understand that my parent/legal guardian will also sign this form before my
application is considered complete.*
Student’s name (please print): Age: Birthdate: / /
month day year
Student Signature: Today’s date:
month day year
*Parent/Legal Guardian’s Name (please print):
*Parent/Legal Guardian’s Signature: Today’s Date:
month day year
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Green River College - International Programs Student Application

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Completed 6 May 2020

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