Enrollment Services
International Student Information
Complete this form and return to the International Student Affairs office, SSC room L156, or mail to MCC International Student Affairs, MS #12, P.O. Box 1046, Manchester
CT 06045-1046. For more information, call 860-512-3204.
STUDENT INFORMATION
First Name MI Last Name
Date
Permanent Address in Home Country
City State Zip
How long have you lived at this address? (years, months) Home Phone Cell Phone
Date of Birth Country of Birth Country of Citizenship
United States Drivers License? (if applicable)
n
Yes
n
No
If yes, what state? Driver’s License Number/State ID Date License/ID Issued
High School Attended Location
Last College Attended Location
Dates Attended College
Semester/year from: to
Degree Awarded
Graduation Year
CONTACT/SPONSOR INFORMATION
Contact/Sponsor Name
Contact/Sponsor Address
City State Zip
Contact/Sponsor Home Phone Contact/Sponsor Cell Phone
Relationship to Student
STUDENTS ON UNITED STATES NON-IMMIGRANT VISAS
Are you on a visa?
n
Yes
n
No
If no, are you a permanent resident?
n
Yes
n
No
If yes, what type of visa? Expiration Date Date Arrived in the United States
February 2020/PR
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