VRH 01/2017
Davidson County Community College
International Application Addendum
Country of Birth: _________________________Country of Citizenship: _________________________
Current Visa Status (if applicable): _____________________________________________________
Are you an F-1 student at another college or university? ___ Yes ____ No
If yes, please list the name of the college or university.
_________________________________________
Non-U.S. Permanent Address:
_______________________________________________________________
City:
_____________________________________________ State/Province: ______________________________
Zip/Postal Code: ______________________ Country: ________________________________________________
U.S. Address (if known): _____________________________________________________________________
City: _____________________________________________ State/Province: ______________________________
Zip/Postal Code: ______________________ Country: ________________________________________________
Marital Status: ___ Single ___ Married
If married, are you bringing your spouse/children with you? ___ Yes ___ No
If yes, please list the names and relationships to you?
Name: __________________________________ Relationship: ___________________
__________
Name: __________________________________ Relationship: ___________________
__________
Name: __________________________________ Relationship: ___________________
__________
What is your intended program of study?
___________________________________________________
Entry Semester: Fall (August) ____ Spring (January) _____ Year _____
How do you plan to meet the English language requirement for DCCC?
(Please check only one)
Appropriate TOEFL Scores
DCCC Placement Tests
Successful Completion of English course at U.S. College or University
Secondary school diploma or bachelor’s degree from a country on the English Language
Requirement Exemption list
Emergency Contact Information
Name of Contact:
___________________________ Relationship to Student: __________________________
Phone Number: __________________________ Email: _______________________________________________
Address: ______________________________________________________________________________________
City:
__________________________________ State/Province: _________________________________________
Zip/Postal Code: ______________________ Country: ________________________________________________
Date Processed by Student Records Office: ________________________ Records Staff Initials: _________________
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