Southwestern Michigan College
International Student Application for Admission
Personal Information *Required
Please enter your full legal name exactly as it appears on your passport.
Last N ame/Family Name* ________________________________________________________
First Name/Given Name* ________________________________________________________
Middle Name ________________________________________________________
Other Names Used ________________________________________________________
Date of Birth (Month/Day/Year)*
Gender* Male Unknown/Other
City and Country of Birth* ________________________________________________________
Country of Citizenship* ________________________________________________________
Native or First Language* ________________________________________________________
If you are currently in the United States, what type of visa do you hold? (F-1, B-2, H-4, etc.) __________
Will your s
pouse and/or children accompany you to the United States?
Contact Information
Home Country Address* ________________________________________________________
City* ________________________________________________________
State/Province ________________________________________________________
Postal Code ________________________________________________________
Country* ________________________________________________________
Home Phone* ________________________________________________________
Email Address* ________________________________________________________
Enter a mailing address only if it is different from the home country address provided above.
Mailing Address ________________________________________________________
City __
State/Province ________________________________________________________
Postal Code ________________________________________________________
Country ________________________________________________________
Cell Phone (U.S. only) ________________________________________________________
By providing your U.S. cell phone numbe r, you agree to receive informational text messages from SMC.
Do you want to make all your contact information confidential?* No
Revised 9/10/19 1
Fall (September)
Educational Information
Name of High School/Secondary School* __________________________________________________
Location (Ci
ty and Country)* __________________________________________________
Type of Certificate/Degree/Diploma* __________________________________________________
Graduation Date (Month/Day/Year)*
If y
ou have attended any post-secondary colleges or universities, please enter this information below.
Name of Col
lege/University __________________________________________________
Location (C
ity and Country) __________________________________________________
Dates of Attendance (Month/Day/Year) to
Name of College/University __________________________________________________
Location (C
ity and Country) __________________________________________________
Dates of Attendance (Month/Day/Year) to
If y
ou have attended more than two colleges or universities, please attach a separate page with the above
details for all the other institutions you have attended.
Intended Course of Study
Enter t he f our-digit code from page 4 for the program you wish to enter* ______________
In which of the following semesters do you plan to start attending SMC?*
Spring (J
anuary) Summer (June) Ye
ar ___________
Please note that only transfer students who are currently studying in the United States may begin their studies at SMC in the Spring
or Summer semesters. All other students must apply for the Fall semester.
Housing Needs
Single students only: Do you plan to live on campus? Yes
Emergency Contact Information
If the person below cannot be reached in the event of an emergency, I hereby authorize the college to
send me to the hospital or physician most readily accessible and/or to administer emergency care.
Last Name/Family N
ame* ________________________________________________________
First Name/Given N
ame* ________________________________________________________
Relationship to Applicant* ________________________________________________________
Phone* ________________________________________________________
Email Address* ________________________________________________________
Revised 9/10/19 2
Background Information
The college requires that all applicants reply to the following questions about their background. Failure to
complete and honestly answer background questions may delay your admission.
1. Have y
ou ever been charged or convicted of any felony, misdemeanor, or crime in any state or
country (including sealed cases, unless expunged)?* Yes No
If y
es, please list original date of offense and convicted charge with date of offense (if different
from original charge):
Have you ever been suspended or expelled, or are you currently facing disciplinary charges at any
educational institution?* Yes No
If yes, ch
eck all that apply:
Suspended Expelled Currently Facing Charge
Please give a complete explanation and list dates. Attach a separate page if needed.
Notice to Applicants with Criminal Records
Applicants with felony, misdemeanor or criminal convictions may not be accepted to academic programs
that require an internship or clinical hours. Moreover, applicants to certain programs are required to
submit a criminal background check. SMC does not in any way guarantee that students with prior criminal
convictions will be able to 1) complete their academic program, 2) attain health occupations licensure in
the state of Michigan or 3) be able to secure employment upon completion of a program.
Equal Opportunity Policy
Southwestern Michigan College is committed to a policy of equal opportunity for students, faculty and
staff. The college complies with all federal laws and regulations prohibiting discrimination including Title
VI, Title IX, Section 504, and Title II of the Americans with Disabilities Act and with all requirements and
regulations of the U.S. Department of Education. The college’s occupational educational opportunities will
be offered without regard to race, color, national origin, sex or disability.
Inquiries regarding this policy and/or application of Title VI, Title IX, Section 504 or the ADA may be
referred to Brent Brewer, Chief of Staff, David C. Briegel Building, room 2104, 58900 Cherry Grove Road,
Dowagiac, MI, 49047, 269-782-1276.
Read Before Signing: By signing, I certify that all of the answers given in this application are complete
and accurate to the best of my knowledge. If I have provided any false information or omitted any
information or provided only partial information, I understand that I may not be admitted to the college. If
false information is discovered after I am enrolled, I may be immediately expelled from the college and
my nonimmigrant status will be terminated. I certify that I have reviewed and will abide by the Student
Code of Conduct, and I understand that my nonimmigrant status is contingent on my academic
performance and my adherence to the Student Code of Conduct.
Signature: _ ____________________________________________ Date: ________________
Revised 9/10/19 3
click to sign
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4001 Accounting
4002 Automotive
4009 Information
4064 Business
4075 Criminal
4065 Information
4033 Medical
4022 Early
Childhood Education
4027 Engineering Technology*
4028 Graphic
4060 Health
4079 Paralegal
4074 Robotics
4059 Social
4077 Sports
Approved Programs of Study for International Students
Associate in Arts
For students planning to continue their education at a university after completing an associate degree.
0502 Business
0500 Communication
0037 Creative
0506 Music
0012 Elementary
0033 Paralegal
0016 English
0026 Psychology
0501 Social
0039 General
0505 Visual
Associate in Science
For students planning to continue their education at a university after completing an associate degree.
3504 Biology an
d Medical Pre-Professional
3503 Environmental Sci
3505 General
3502 Science/Engineering/Math
Associate in Applied Science
For students planning to enter the workforce after completing an associate degree.
*These programs are also designed for students planning to continue their education at a university.
Revised 9/10/19 4