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Butte College
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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: _____________________
(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 ______
HO
ME COUNTRY – PERMENANT ADDRESS
U.S. CURRENT ADDRESS (If available)
______________________________________________________
NUMBER & STREET
_________________
_____________________________________
CITY STATE POSTAL CODE
__________________________________________________
N
UMBER & STREET
______________________________________________________
CELL OR TELEP
HONE NUMBER
_________________________________________________
CITY STATE/PROVINCE/PREFECTURE
_________________________________________________
COUNTRY POSTAL CODE
__________________________________________
CELL OR TELEPHONE NUMBER
For office use only
Student ID # ___________________
In The U.S Application ____________________________________
MALE FEMALE
UNKNOWN / OTHER