Fill - Free fillable Southern Union State Community College (Southern Union State Community College) PDF form

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Southern Union

State Community College

Student Development Division

MEMORANDUM

TO: INTERNATIONAL STUDENTS

FROM: GARY BRANCH, DEAN OF STUDENT DEVELOPMENT

NOTE: You must submit your International Student Application for Admission at least three

(3) months prior to the beginning of the semester in which you hope to be admitted to the

College in order to be issued an I-20.

Thank you for your interest in Southern Union. Read the instructions and information in this packet

carefully. First, you must complete the Application for General Admission. You will receive a letter

from our Registrar with this packet of instructions. Then, prospective international students must

submit all of the following documents listed below to Madisen Cope at the address provided

herein, before further consideration may be given to the student’s admission or enrollment process.

Please note: Southern Union requires official documents. Official documents and/or transcripts must be

mailed from educational institutions and/or testing agencies to the Southern Union Admissions Office.

_____1. Submit a college application for general admission

_____ 2. Completed Application for International Students.

_____ 3. Official High School and College Transcripts (if applicable) Indicating Graduation Date.

(Transcripts from high schools and colleges in foreign countries must be translated

in English and submitted to one of the following evaluators.)

(1) Educational Credential Evaluators, Inc.

P.O. Box 514070, Milwaukee, WI 53203-3470

Phone: (414) 289-3400

Website: www.ece.org Email: eval@ece.org

OR

(2) World Education Services

5087 Bowling Green Station, New York, NY 10274-5087

Phone: (212) 966-6311 or (800) 937-3895 Fax: (212) 739-6100

Website: www.wes.org Email: support@wes.org

OR

(3) Josef Silny & Associates, Inc.

7101 SW 102 Avenue, Miami, FL 33173

Phone: (305) 273 -1616 Fax: (305) 273-1338

Website: www.jsilny.org Email: info@jsilny.org

______4. U.S. Official College Transcripts (if applicable). A Transfer Clearance Form must also

be submitted for students who are or were enrolled in any U.S. college or university.

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______ 5. Minimum Official TOEFL score of 550 pbt, 213 cbt, or 79 ibt. The Test of English as a

Foreign Language (TOEFL) must be taken by each international student whose national

language is not English and who did not graduate from an English speaking high school.

Official scores should be sent from the Educational Testing Service (ETS/TOEFL), to

Southern Union State Community College (Institutional Code:1728) prior to a decision on

admission.

______ 6. Proof of Adequate Health/Accident Insurance. Documentation demonstrating adequate

health and life insurance must be maintained detailing all periods of enrollment and must

include a repatriation clause of $25,000 or more.

_____ 7. Sponsor. The Sponsor Support Form must indicate that he/she will be

responsible for the student while they are in the United States. A sponsorship form is

attached for your convenience. This form requires documentation.

_____ 8. Financial. The college requires the Financial Support Form to be on file. This letter

should indicate that the student will have at least $35,850 (United States currency)

available in the United States for their expenses while they are enrolled. Financial aid is

generally not available to international students.

_____ 9. Immunization/Medical Form. Must be completed and signed by a medical physician or

authorized health care professional.

*Note: International students are required to be enrolled full-time (12 semester/contact hours or more)

during the fall and spring semesters. However, they can be part-time, or do not have to be enrolled during

the summer term. This is the college’s “break period” regarding international student enrollment. There

are very limited exceptions to this policy; however, international students can drop below full-time

enrollment if it is the final term for the completion of their program of study (graduation).

Mail all official documents to:

Madisen Cope, International Student Coordinator

Southern Union State Community College

301 Lake Condy Road

Opelika, AL 36801

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Southern Union

State Community College

Student Development Division

International Student Application for Admission

(Students must first complete the General Application for Admission in person at

the Admissions Office.)

Students must complete requirements outlined in the attached International

Student Packet before a decision on admission can be made. Complete

application by typing or printing all information requested. Return to:

Madisen Cope, International Student Coordinator

Southern Union State Community College

301 Lake Condy Rd.

Opelika, AL 36801

1. What semester would you like to begin your course work? _______________________

Date

Have you ever applied to Southern Union before? ______Yes ______No

2. Name:__________________________________________/________________________/_____________

Family Name (as listed on your passport) First Middle

Social Security Number:_________________/_________________/__________________

3. Sex: ___Male ____Female Date of Birth:____________/_______/________

Month Day Year

4. Country of Birth:______________________ Country of Citizenship:______________________________

5. U.S. Mailing Address____________________________________________________________________

(Street and Number) City State/Zip

Home Country Address: _________________________________________________________________

__________________________________________________________________________________

______________________________________________________________________________________

Telephone Number:_______________________ Email:_______________________________________

6. Person to be notified in an emergency:

Name:______________________________/___________________ Relationship:________________

Address:__________________________________________Phone Number:________________________

7. Major/Program of Study that you plan to pursue:______________________________________________

List name of transfer school, if

applicable____________________________________________________

9. If you are now in the United States, what type of visa do you have? _____________________________

Please send copy of your passport. Type of Visa

I understand that withholding information requested in this application, or giving false information, may make me

ineligible for admission to, or continuation in the college. I agree to abide by the rules, policies, and regulations of

the college as outlined in the college catalog and student handbook. Further, I understand that if I am accepted for

admission to Southern Union, I must also follow the rules and regulations for international students as outlined by

the Immigration and Naturalization Service. With this in mind, I certify that all the above statements are correct

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and complete.

APPLICANT'S SIGNATURE:____________________________________________DATE:__________________

Official Statement of Finances

It is my understanding that the approximate cost of college education for one student at Southern

Union State Community College is $35,850 (U.S. Currency) for each twelve-month academic

year. This includes tuition, fees, room and board, books, and personal expenses. It does not

include the cost of transportation to and from the United States. (Even though some students

may choose not to attend school during the three-month summer term, they must provide

evidence of the ability to pay all expenses incurred per year in order to obtain a Form I-20.)

It is hereby declared that $35,850.00 (U.S. Currency) will be available per twelve-month

academic year for me as long as I am enrolled as a student at Southern Union State Community

College.

I have attached hereto a certified statement from my bank or other certified evidence of my

capability to fulfill this sponsorship.

____________________ _________________________________

Date Signature of Student

Sworn to and subscribed before me this the ______ day

of ______________ 20___

_________________________________

Notary Public

(Affix

Seal)

_________________________________

Date Notary Public Commission Expires

Student's Printed Name: ______________________________________________________

Student's Phone Number: ______________________________________________________

Student's Mailing Address: _____________________________________________________

*NOTE TO APPLICANT: Please return this completed form with your

Application for International Students to:

Madisen Cope, International Student Coordinator

Southern Union State Community College

301 Lake Condy Rd.

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Opelika, AL 36801

Official Declaration For Sponsorship

(Obligation commences when the alien enters the United States and continues until the alien’s departure)

It is my understanding that the approximate cost of college education for one student at Southern Union

State Community College is $35,850 (U.S. Currency) for each twelve-month academic year. This includes

tuition, fees, room and board, books, and personal expenses. It does not include the cost of transportation

to and from the United States. Even though some students may choose not to attend school during the

three-month summer term, they must provide evidence of the ability to pay all expenses incurred per year

in order to obtain a Form I-20.

It is hereby declared that __________________________ (U.S. Currency) will be available per twelve-

month academic year for _____________________________ as long as he/she is a student in the United

States. (Student's Name)

I further certify that I will provide sufficient funds to pay for any and all educational and living expenses

of the above named prospective student and certify that the prospective student will not become a public

charge during his/her stay in the United States of America.

I have attached hereto a certified statement from my bank and/or other certified evidence of my capability

to fulfill this sponsorship.

___________________________________ Sworn to and subscribed before me this the _______

Signature of Responsible Financial Sponsor day of _______________________ 20_____

____________________________________ ______________________________

Date Notary Public Commission Expires Notary Public

(Affix Seal)

Sponsor's Printed Name: _________________________________/Phone #:__________________

Sponsor's Relationship to Student: ___________________________________________________

Sponsor's Place of Employment: _________________________/Phone #:____________________

Sponsor's Mailing Address: _________________________________________________________

NOTE TO SPONSOR: Please return this completed form along with other required documentation to Madisen Cope,

International Student Coordinator, Southern Union State Community College, 301 Lake Condy Rd., Opelika, AL 36801

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Southern Union

State Community College

Student Development Division

All information cited herein must be submitted to: Madisen Cope, International Student Coordinator,

Southern Union State Community College, 301 Lake Condy Rd., Opelika, AL 36801, prior to a decision on

admission and enrollment. After all documents have been mailed, call Madisen at 334-745-6437,

Ext. 5494 to discuss the status of your file. Allow a minimum of 4-6 weeks for normal processing, change-

of-status requests can take up to four months.

The following is a minimum estimate of costs for three semesters. This does not include transportation costs

to and from the United States.

Tuition and Fees $11,850

Books and Supplies 2,800

Room and Board 14,400

Transportation 2,900

Personal and Misc. 3,900

TOTAL $35,850 (Revised 9/17)

(Subject to change without notice)

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Transfer Clearance Form

(TO BE COMPLETED ONLY IF YOU ARE CURRENTLY STUDYING

OR HAVE STUDIED IN THE U.S.)

Please date and sign this form and ask your present International Student Advisor (or equivalent school official) to complete the

form and return it along with your official transcript to the following office. This form must be completed prior to any action

taken on your application.

Madisen Cope, International Student Coordinator

Southern Union State Community College

301 Lake Condy Rd.

Opelika, AL 36801

Telephone: (334) 745-6437

Fax Number: (256) 395-2215

I request and authorize my present International Student Advisor (or equivalent school official) to mail my student transcript and

provide information below as part of my application for admission to Southern Union State Community College.

_________________________________________ _______________________________________/__________________

(Print) Full Name Signature Date

THE FOLLOWING SHOULD BE COMPLETED BY YOUR INTERNATIONAL STUDENT ADVISOR

_________________________________________________________________________________________________________

Applicant's Full Name

_________________________________________________________________________________________________________

Applicant's Present Address

Country of Citizenship_____________________________________ Country of Birth:___________________________________

Visa Type:_______ Expiration Date:_______ Admission Number:_______________________

________________________/_________________________________/____________________________/__________________

Name of Sponsor/Address of Sponsor Relationship Sponsors Phone #

School issuing I-20 for initial entry into the U.S.A.___________________________________________________________

I-20 Expiration Date:_________________________________________

Date applying for transfer (circle one): Fall 20___ Spring 20____ Summer 20_____

Has this student pursued a full course of study as required by INS regulations for maintaining status on an F-1 Visa?

Yes____ No____

If F-1 student, is student currently attending the school he/she was last authorized to attend by the US Immigration and

Naturalization Service? Yes____ No____

Has the student had any financial difficulties while attending your school? If so, please explain on the back of this form.

Yes____No____

School Official Title Signature Date

__________________________________________________________________________________(_____)_______________

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Address and Telephone Number of the Institution

Form Revised 6/15

Southern Union State Community College

Immunization Form

To ensure the health and safety of our campus, immunizations against communicable disease is

extremely important. Vaccination against Measles, Mumps, Rubella (MMR), Tetanus, and

Meningococcal is required, as well as a negative Tuberculosis skin test. This is a requirement for all

International Students. This form must be completed and submitted prior to admission in any ACCS

institution.

_____________________________________________________________________________________

Last Name First Middle SSN/ID#

_____________________________________________________________________________________

Street City State Zip

Cell Phone:_____________________ Date of Birth: _____________ Email: ____________________

Section A: Required Immunizations/Tests

Month/Day/Year

1. Meningitis Vaccine- within the last 5 years (Menomune, Menactra, Menveo)

2. Measles, Mumps, Rubella (MMR)

3. Tetanus

4. Tuberculosis Screening

TB Skin Test by PPD

Date Placed

Date Read

MM

Neg Pos

Chest X-Ray (if positive PPD or lab)

Date

Result

Submit copy of chest X-ray report

Section B: Recommended Immunizations

Please attach documentation of all childhood vaccinations (copy of Blue Card)

Month/Day/Year

Titer Date & Result

TD (Tetanus/Diphtheria)

Do not write here

AND/OR Tdap (Tetanus/Diphtheria)

Do not write here

Polio

Do not write here

Hepatitis B

Varicella (Chickenpox)

Do not write here

I

I certify that the above dates and vaccinations are true:

_______________________________________________________________________________________

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Signature of Licensed Health Care Professional or Authorized Individual Date

Complete and return to: Madisen Cope, International Student Coordinator, 301 Lake Condy Road Opelika, AL

36801

ACCS Institution: Southern Union State Community College

Medical History Form

This portion is to be completed by the student:

____________________________________________________________________________________

Last Name First Middle SSN/ID#

_____________________________________________________________________________________

Street City State Zip

Cell Phone:_____________________ Date of Birth: _____________ Email: _____________________

This medical data is necessary to serve as a baseline for medical clearance for actual enrollment. Details of

abnormalities should be recorded. Please check YES or NO to the following conditions.

CONDITIONS

NO

YES

Hypertension

Rheumatic fever or heart trouble

Liver trouble or jaundice (Hepatitis)

Asthma or tuberculosis

Major surgery or injury

Ulcers or gastroenteritis

Backache or joint trouble

Kidney trouble

Diabetes

Severe headaches

Epilepsy or convulsions

Dyspnea

Drug or alcohol problem

Has applicant been treated for any emotional disorders?

Has applicant, because of his/her health, withdrawn from college? If so explain

Does the applicant have any illness or medical condition that requires regular treatment?

Does the applicant miss school regularly or frequently due to any physical condition?

Has the applicant been hospitalized?

Any family member with chronic illness, mental or nervous disorders?

Anemia

Learning disability

Comments:

Present

Health:

Good

Fair

Poor

Date of last exam:

/ /

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Complete all medical forms and return to: Madisen Cope/ International Student Coordinator/ 301 Lake Condy Road, AL 36801

ACCS Institution: Southern Union State Community College

This portion is to be completed by a Physician:

Height: _______ Weight:___________ Skeletal Size: Small____ Medium ____ Large____ EL_____

B/P: ____________ Pulse: ___________ Respiration: ________________ Temperature: _____________

Laboratory Findings:

Hemoglobin or Hematocrit _____________ WBC ________________ Serology ________________

Urine: Sp. Gr ___________ Alb _______________ Sugar _____________________

Head, Neck and Face

Normal ( )

Abnormal ( )

Nose and Sinuses

Normal ( )

Abnormal ( )

Mouth and Throat

Normal ( )

Abnormal ( )

Teeth

Normal ( )

Abnormal ( )

Lungs and Chest

Normal ( )

Abnormal ( )

Heart

Normal ( )

Abnormal ( )

Vascular System

Normal ( )

Abnormal ( )

Abdomen

Normal ( )

Abnormal ( )

Endocrine System

Normal ( )

Abnormal ( )

Female: Breast

Normal ( )

Abnormal ( )

Female: Pelvic

Normal ( )

Abnormal ( )

Male: Genital

Normal ( )

Abnormal ( )

Male: Hernia

Normal ( )

Abnormal ( )

Present Health: Good_______ Fair__________ Poor__________ Date of Exam: _________________

Eyes

Do you wear glasses?

No

Yes

Do you wear contacts?

No

Yes

Distant Vision

Without glasses

R20/

With glasses

R20/

Near Vision

Without glasses

R20/

With glasses

R20/

Ears

No

Hearing normal? Yes

Are drums intact? Yes

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I certify that the above information is true: Physician’s Signature: ______________________________

Student’s Signature: _______________________________

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