Name of Intended Major: Secondary Major
Please mark your answer to the following questions (do not leave anything blank):
Education Goal: □ ESL Study □ Certificate of Achievement □ Associate degree (AA or AS degree)
□ Associate degree and transfer to a four-year university for BA/BS degree
□ Transfer to a four-year university without earning an Associate degree
Enrollment Status: □ New - Never attended college
□ Transfer Student - Attended other colleges, but not Santa Ana College
Ethnic Background: □ Asia - Chinese □ Asian - Korean □ Asian - Japanese □ Asian - Vietnamese
(Check only one) □ Black, Non-Hispanic □ Filipino □Hispanic - Mexican □ Hispanic - Central American
□ Other - Hispanic □ Hispanic - South American □ Pacific Islander □ Southeast - Asian
□ White, Non-Hispanic □ Other_________________________
Visa Information: (complete the fol
lowing if you are currently in the United States)
Check your current visa status: □ F-1 □ F-2 □ B-1 or B-2 □ H-1 □ E-1 □ L-2 □ Other: __________________________
Date of last entry to the United States: _______
_______________ Visa expiration date: _____________________
mm/dd/yyyy mm/dd/yyyy
I am applying as (check one only):
□ A new student from a country outside the United States
□ An F-1 visa transfer student currently studying in the United States (specify current school):_____________________
□ A change of status student from within the United States (please specify your current visa status): ________________
□ Other (please specify): ___________________________________________________________________________
Admission Test: Check the admissions tests taken or to be taken.
Did you take the English proficiency test within the last two years? □ Yes □ No If yes, please attach copy of score
□ English Proficiency: Test Name: _____________________ Date of test: _____________ Test score: ___________
□ TELD: I do not have a TOEFL score of 500. I will take the Santa Ana College Test of English Language Development
(TELD) upon arrival. I understand that I must pass the test at N55 level in order to begin college credit classes. If I score
below the required level, I will register in the English Language Academy at Santa Ana College to improve my language
skills, before beginning college classes.
Do you have any F-2 visa dependents (spouse or child)? □ Yes □ No
If yes, please list the information of each dependent and attached passport for each dependents:
Last
Name: First Name:
Surname Given Name
Middle Name: Date of Birth: □ Male □ Female
mm/dd/yyyy
Country of Birth: Country of Citizenship: Relationship:
Last
Name: First Name:
Surname Given Name
Middle Name: Date of Birth: □ Male □ Female
mm/dd/yyyy
Country of Birth: Country of Citizenship: Relationship:
If you are in the U.S., will you be travelling outside the U.S. before beginning your studies at Santa Ana College?
□ Yes □ No
How did you hear about our colleges?
□ Santa Ana College Student □ Family Member or Friend □ Magazine (please specify): __________________________
□ USA Overseas Information Centers/Agency: _______________________ □ Internet (please specify): _____________
□ Educational fair/School visit: ____________________ □ Other:__________________________________________
I certify that I have carefully considered each question above and that my statements are true and complete to the best
of my knowledge. By signing on this line, I understand and acknowledge that I must attend two full semesters and/or
complete program before transferring.
Date: ________________ Applicant’s Signature: _____________________________________________________
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signature
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