Fillable ISapplication ISapplication pages 1and 2.pdf

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ISapplication ISapplication pages 1and 2.pdf

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Country of origin: US
File type: PDF

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FALL SEMESTER SPRING SEMESTER
PLEASE TYPE
INFORMATION ON THIS FORM
Name in full (AS IT APPEARS ON YOUR PASSPORT):
_____________________________________________________________ _______________________________ _______________________
Last name First Name Middle Name
Complete Address (I-20’s will be mailed to this address):
_____________________________ ______________________________________________________ _________________________________
Number Street City
______________________________________________ ______________________________ _________________________________________
Province/Territory/State Postal/Zip Code Country
Email Address: ________________________________________________________ Phone No.:__________________________________________
TOEFL TEST DATE: ______________________________ TOEFL SCORE: ____________________________________________________________
MAJOR/CAREER GOALS TO PURSUE AT MESA COLLEGE:
________________________________________________________________________________________________________________________
EDUCATIONAL GOAL:
ASSOCIATE DEGREE ASSOCIATE DEGREE AND TRANSER FOR BACHELOR’S DEGREE TRANSFER ONLY
If you plan to transfer to another college after San Diego Mesa College, please indicate the institution/s and major/s you are considering:
__________________________________________________________ __________________________________________________________
College/University Major
BIOGRAPHICAL DATA
Passport Number: _______________________________________________ Date of Birth: ____________________________________
(Month/Day/Year)
Gender: Male Female Country of Birth:_______________________________________________
____ ____ _______________ Country CountryCof Citizenship: _______________________Native Language: __
Country of Legal Residence: ______________________ Countyr of Citizenship: _________________________ Native Language:_______________
Complete Home Country Address: ____________________________________________________________________________
Home Country Phone: _________________________________________ Marital Status: Single Married
*If married, list the name, relationship and date of birth of any dependents traveling to the United States with you:
_____________________________________________________________________________________________
FOR STUDENTS ALREADY IN THE UNITED STATES
Date of the last entry into the United States: ___________________ Visa Type (B2,F1,F2,etc.) ___ Expiration date: ______________________
(Month/Day/Year) (Month/Day/Year)
If your Visa status was changed, when was the change approved by INS: _______________________
(Month/Day/Year)
I-94 Number: ____________________________________________ I-94 Expiration date: _______________________________
(Month/Day/Year)
List institutions that issued you an I-20: ________________________________Did you attend that institution on an F1 visa? ________________
Dates attended: ________________________________________________________________________________________________________
If you have a Social Security Number, please list: ______________________________________________________________________________
Do you plan to process your San Diego Mesa College I-20 outside the United States? Yes No
This form is also available online at:
www.sdmesa.edu/international
International Student Application
7250 Mesa College Drive San Diego, CA 92111-4998
(619) 388-2717
ATTACH PHOTO
HERE
OFFICIAL TRANSCRIPTS ARE REQUIRED FROM ALL UNITED STATES SCHOOLS ATTENDED
Show in chronological order all schools and colleges you have attended and all diplomas or certificates you earned
at these schools. List all years from first year of elementary or primary school (not Kindergarten). If you are currently
attending classes, please indicate the exact date (day, month, year) your current semester will end.
OFFICIAL TRANSCRIPTS & ENGLISH TRANSLATIONS IF NEEDED ARE REQUIRED
FROM HIGH SCHOOL AND ALL COLLEGES ATTENDED.
Attendance Dates:
FROM
TO
Month/Year Month/Year
Name of School
and
Country
Grades
or
Levels
Certificates or
Units/Diploma/Degrees
Received
Grades
Received
or GPA
CERTIFICATION AND RELEASE OF INFORMATION
Please provide names of anyone you wish to authorize to obtain information about you,
your application or your enrollment status.
NAME RELATIONSHIP PHONE NO.
1.
2.
3.
4.
5.
By signing below I acknowledge that I have read and understand the admissions information in its entirety.
I declare under penalty of perjury that all information provided refers specifically to me and is true and correct.
I understand that falsification or withholding information requested on this form shall constitute grounds for dismissal.
Name of Applicant (Please Print) _______________________________________________________________________
____________________________________________________________ _____________________________________
Signature of Applicant Date
TO
TO
TO
TO
TO
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ISapplication ISapplication pages 1and 2.pdf

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Completed 27 February 2020

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