Fillable Merced College Application 2016

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Merced College Application 2016

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Merced College Internaonal Student Services
Admission Applicaon
Thank you for your interest for Merced College. Our staff will make every effort to assist you.
Our admission requirements conform to the regulaons of the U.S. Government for issuing F-1 student visas.
If you have any quesons regarding enrollment or compleng this form, please call our Internaonal Student Services
Office at (209) 384-6229 or e-mail us at internaonalstudent@mccd.edu.
Deadlines:
Fall Semester …… June 15
th
Spring Semester …… November 15
th
Summer session …… April 15
th
These deadlines could be extended upon special circumstances
Requirements for admission Checklist
Complete applicaon online
Submit a $100.00 non-refundable processing fee by credit card or internaonal money order payable to Merced
College.
Submit a guarantee of financial support form signed by your sponsor if applicable.
o Aach an original bank statement verifying that the sponsor has at least $17,000 U.S. dollars available for
the first year of your expense. See aached form.
Submit an official transcript of your high school and post-secondary school translated in the English
language. A transfer clearance form is required if you are aending another educaonal instuon in
the United States. Use this link to download the form: transfer clearance
Submit an autobiographical essay (approximately 500 words). State your educaon, special interests, reason for
applying to Merced College, and your educaonal goals aer compleng your studies at Merced College.
Submit a leer of academic recommendaon which explaining your educaonal achievements and goals.
Sign a prospecve Internaonal student acceptance agreement form.
Submit documentaon of a complete health examinaon by a physician. Must include current
immunizaon dates and verified tuberculosis clearance. See aached form.
English language proficiency requirement
By Exam: Send copy of official TOEFL score 45 iBT/450 PBT, IELTS 5.0, or Eiken 2A or beer.
Or Compleon of college level English at a U.S. instuon
Important steps:
o Health insurance coverage proof upon arrival. Merced College internaonal students must maintain their
health insurance coverage at all mes.
o You will receive an acknowledgement form Merced College regarding your acceptance, shortly aer
receipt all of your applicaon. It will contain further instrucons on obtaining the F-1 Visa. Issuance of
the I-20 will only take up to 1 week from receipt of your applicaon at Merced College.
o Once you receive your I-20, yo
u must pay SEV
IS fee of $200 online at FMJfee.com before the F-1 visa
interview.
o Applicaon packet is also available to download online.
Enrollment Informaon
Indicate semester for which you are applying:
Fall/August 20_____ Spring/January 20_____ Summer/June 20_____
Legal Name: _______________________/_____________________/___________________Sex: Male Female
Last First Middle
Home country address: Number & street name: ___________________________________________________,
City: _______________________, State/Province: _________________________, Zip: ___________________,
Country: _________________________ Home Phone number: (________) _____________________________
Birth Country: ____________________ Birth Date: ______month/______day/______year (e.g. 08/23/1992)
Country of Cizen: ________________________, E-mail address: _____________________________________
Intended Major to study at Merced College (Academic Program) _____________________________________
Address where the I-20 should be mailed as it would appear on an envelope
Number & Street name: _____________________________________________, City: _____________________
State/Province: _____________________________, Zip: __________________, Country: __________________
Your goal:
Two-year Associate Degree Associate/University Transfer Cerficate program compleon
Educaon
List high school, college/university, and/or language schools you have aended. Official secondary and post-
secondary transcripts translated into English must be submied.
Name of school
Locaon (City, Country)
Dates of Aendance
(Month/Year to Month/Year)
Diploma/Degree (if any)
English Proficiency Requirement
To sasfy Merced College’s language proficiency requirement for admission, I have completed one of the following:
Received a minimum score or higher on TOEFL (450 PBT or 45 iBT), IELTS (5.0), EIKEN 2A
Name of exam: ____________________ Test Date: _____________________ Score: ___________________
See list of countries where TOEFL scores are may be waived.
Completed prerequisite course for college level English at a U.S. instuon.
Provide the school name: ____________________________________________
Please send the official copy of your transcript.
I do not have a TOEFL or other English test score and will enroll in English Language Instute at Merced College
prior to starng college program. [see MCELI applicaon]
I will enroll in English Language Instute only. [see MCELI applicaon]
Referral/Agent Informaon
How did you learn about MERCED COLLEGE?
MC Website Relaves/Family School/Agency Other:____________________
Please provide the informaon about your agency:
Agency Name: ____________________________ Contact Person: ________________________
Email address: ____________________________ Address: _____________________________________________
Do you need transportaon upon your arrival to the U. S.? Yes No If yes, apply at YES website
Will you need host family placement services (homestay)? Yes No If yes, apply at YES website
If your spouse and/or children will be accompanying you, please complete and submit a separate applicaon form
for each person.
Acceptance Agreement
Merced College Internaonal Student Services requires that all students remain enrolled in Merced College for a
period of at least one semester in college credited courses before requesng a transfer to another instuon.
Students aending the Merced College English Language Instute (MCELI) must complete the program and enroll
in Merced College credit courses for at least one semester aer compleng the MCELI program before a transfer
will be approved. No request for transfer will be considered unl the specified condions have been met. The
dir
ector/PDSO of Internaonal Student Services will review transfers for approval.
By signing below you acknowledge that you have read the following and agree to the condions of acceptance.
___________________________________________
Prospecve Student Signature Date
MERCED COLLEGE
HEALTH EXAMINATION REPORT
Last Name First Name Middle Name
A Physical examination by a medical Doctor (M.D.) is required.
Current immunizations (with dates specified) verified Tuberculosis clearance must be completed before
your arrival at Merced College.
1. TETANUS (Must be within the past 9 years) DATE: _____________________
2. MEASLES, RUBELLA (Must be given after 1970 and after 12 months of age)
MEASLES (RUBEOLA) DATE: __________________________
RUBELLA DATE: __________________________
3. TUBERCULOSIS CLEARANCE DATED within the past 3 months of this physical exam:
MANTOUX SKIN TEST DATE: RESULT: ________________
(IF MANTOUX TEST IS POSITIVE, CHEST X-RAY IS REQUIRED).
CHEST X-RAY DATE: ___________RESULT:________________
Does student have any condition which prevents participation in physical education?
If yes, explain: _________________________________________________________________
Current prescription medication: ________________________________________
________________________________________
Special health problems? ___________________________________________________________
I have examined and find him/her in good health and able to attend college.
Signature of physician: _______________________________________
Name of physician (Please print):_______________________________________________
Address: ________________________________________________________________________________
Telephone: _______________________________ Email:_______________________________________
Print This Page Only
Guarantee of Financial Support
The U.S. Department of Homeland Security requires internaonal students to cerfy funds available to cover
all expenses related to living and studying in the United States for a minimum of one year before a form I-20
can be issued by Merced College. Documentaon of financial support includes this form and an original bank
statement(s) showing at least the minimum required $17,000 in US dollar or equivalent.
Esmated expenses for one academic year (Based on 2016-2017 year)
Tu
ion & other fees $6,100 (based on 12 units; minimum required for F-1 visa students)
Books & supplies $800 (esmate for 2 semesters)
Living cost $9,000 (12 months esmated cost to live with host family)
Health insurance $1,300 (1 year premium through student insurance)
Total esmated cost $17,200
Official bank or other financial instuon statement with resent balance.
Income tax receipts and forms.
Financial Sponsor’s contact informaon
Relaonship to student
Country of sponsor
Contact Email address of sponsor
I understand that I am making a financial commitment to the student for the enre me he/she is enrolled and will
not expect the student to pay expenses through employment, which is strictly prohibited by the U.S. government.
I am subming an official bank statement showing a minimum of the esmated dollar amount required for the
student as noted on this form.
$____________________________________ ___________________________________
Available Amount for Student Expenses Name of Bank or Financial Instuon
____________________________________ ___________________________________
Signature of Sponsor Print Name of Sponsor
Date_____________________
Name of Student (Last Name, First Name)
International Student
Services
Application Fee Credit Card Payment Authorization Form
VISA /Master Card Only
Date: ____________________________
Student’s name: ___________________________________________
Credit Card Holder’s Name: __________________________________
Credit Card number: ________________________________________
Security code on back: _________ Expiration Date: ____/_____ Amount: $ ___________
Signature: ___________________________
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Merced College Application 2016

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Completed 24 July 2020

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