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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
Attach Recent Photo
Here
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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
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
Month/Day/Year
Month/Day/Year
Titer Date & Result
TD (Tetanus/Diphtheria)
Do not write here
Do not write here
Do not write here
AND/OR Tdap (Tetanus/Diphtheria)
Do not write here
Do not write here
Do not write here
Polio
Do not write here
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
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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