Fillable Thank you for the interest you have shown (Rose State College)

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Thank you for the interest you have shown (Rose State College)

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Dear Prospective Student:
Thank you for the interest you have shown in Rose State College. I hope that this letter and the enclosed material
will answer some of your questions. Please read all the information in this packet carefully.
Before we can process your application for admission, the International Student Office at Rose State College must
receive each of the documents listed below: (Certified English translations are required for those items so
indicated).
1. A completed and signed Rose State College application for admission and a signed immunization verification
form.
2. Official high school transcript(s) and/or documents indicating the date that all secondary school
requirements were met. A certified English translation must be attached if the transcript is not printed in
English.
3. The completed “Certificate of Support” form and a bank statement for the sponsor certified by a bank official
showing available funds in U.S. dollars. The United States Department of Homeland Security requires all
international students to have sufficient funds to cover all expenses they might incur during their attendance
in college. NOTE: A sponsor cannot be another international student.
4. Proof of English language proficiency: an official International Test of English as a Foreign Language (TOEFL)
score of 61 or higher on the Internet-based exam (173 or higher on the computer-based or a 500 or higher
on the paper-based) is the minimum score that a student must achieve for admission. The Rose State College
school code for TOEFL is 6559 and should be entered on your score sheet when you take the exam. IELTS
exam score reports are accepted with a 5.5 or higher.
If, after review of your documents, you are eligible for admission to Rose State College, an I-20 form will be issued.
You must report to the Office of Admissions and Records at Rose State College as soon as possible after entering the
United States. Your enrollment will be considered for the semester following the date of issue on your I-20. In
addition, you must present proof of health and repatriation insurance prior to completion of formal admission. We
also ask for a copy of a valid passport, and need to know your complete permanent home address in your home
country as well as what major you will study while at Rose State College.
Should you have questions or need additional information, please contact this office.
Respectfully,
Dustin Orrell
Assistant Registrar/Assistant Director of Admissions and Records
Enclosure
1. Please Print or Type
2. Use Black or Blue Pen
3. Do not write in Shaded Areas
4. Abbreviate Where Necessary
ALL INFORMATION MUST BE COMPLETED
The following official documents are required for Admission. Any
exceptions must have the registrar’s Approval.
1. Completed Application for Admission Form
2. High School and/or College Transcript(s), or High School Equivalent
Scores
3. Results from ONE of the following: ACT, SAT, or RSC Assessment
Battery may be required.
4. Birth Certificate, Social Security, or State/Federal Identification card
Rose State College
Student ID Number (7 digits)
First Name Middle Name Last Name Other Name(s) under which your records may appear
Office of Admissions and Records
6420 SE 15th Street
Midwest City, OK 73110
Resident Status: Resident of Oklahoma?
How long? Years Months
Born in the United States
Born Abroad on Military Base
Naturalized Citizen
Permanent Resident
F-1 Student Visa
Other Visa Type or Status
To Be Answered by U.S. and Foreign Students:
English is my second language?
*Official documents required by the U.S. Citizenship and
Immigration Service, Oklahoma State Regents, and Rose State College
must be received and evaluated before an I-20 will be issued.
The following information is optional but is requested for reporting purposes
only in accordance with the 1964 Civil Rights Act, Title VI, as amended.
Do you consider yourself Hispanic or Latino?
Select one or more of the following categories to describe you.
Non Resident Alien Asian
Black or African American White
American Indian Native Hawaiian
or Alaskan Native or Pacific Islander
Tribe Bloodline: Mother
Father
Both
Are you the first person in your immediate family to attend college?
Term Entering
Fall
Spring
Summer
Employer
Work Phone
Hours worked per week
STUDENT’S MAILING ADDRESS
PARENT OR EMERGENCY CONTACT
Street Address City State County Zip Code
First Name Last Name Street Address City State/County Zip Code Phone Number
Social Security Number
Former RSC Student? Yes No Gender Male Female
Date of Birth
Month Day Year
Place of Birth
City State Country (if not U.S.)
Home Telephone Student’s Email Address
1. Active Duty U.S. Military:
2. National Guard or Reserves:
3. U.S. Military Veteran:
4. Dependent of National Guard or Reserve member:
5. Dependent of Active Duty U.S. Military member:
In what state is the active duty member stationed?
Were you (or are you the dependent of someone who was) discharged or released from Actve Duty military
service which lasted 90 days or longer within the past five years, currently residing in Oklahoma, and pursuing
a course of education under Chapter 30 (Montgomery GI Bill) or 33 (Post 9-11 GI Bill) VA educational benefits?
Yes No
Yes No
Supplying your Social Security Number enables a more expedient match of your test scores, transcripts, and financial aid benefits. You cannot receive Federal Financial Aid without providing
your Social Security Number.
Cell Phone
May we text you? Yes No
Yes No
Yes No
Year Entering
Yes No Branch of Service
Yes No Branch of Service
Yes No Branch of Service
Yes No
Yes No
Yes No
Citizenship Status:
If other status, please explain:
Application for Admission
I hereby affirm that all information supplied on this form is complete and accurate. It is my understanding that I shall not be considered for admission to Rose State College until I submit
all required documents. If I am accepted at Rose State College, I agree to abide by the rules and regulations of the College. I also understand that student records are released only in
accordance with institutional policy as provided by the Family Educational Rights and Privacy Act (as amended). As a student of Rose State College, I authorize all other previously
attended educational institutions to release to this college all records pertaining to my academic/student history. I understand that this institution may release student directory information
to other institutions, agencies or individuals unless I specifically, in writing, request otherwise.
Applicant’s Signature Date
Please list all colleges attended since graduation from high school, including current enrollment. List most recent college attended first.
Failure to list any colleges you have attended may result in loss of credit or dismissal from the College.
Name of Institution
City and State
Date Attended
From / To
Hours Earned
PS Code
(For Official Use Only)
High School Graduate:
Name of Last High School Attended
City State
County Code Resident Code Admit Code
PS High School Code
PS Code
(Last college Attended)
Month Day Year Admissions Use
Graduation Year Year Earned
Yes No
High School Equivalency Earned
Yes No
Have you attended any other colleges/universities?
Yes No
What was your academic standing at your last school? Good Probation Suspension
Educational Objectives
Anticipated major (s)
Please select the option or options that best describe your current goals:
Degree or Certificate Seeking:
I plan to earn an Associate degree at Rose State College.
I plan to earn a Certificate at Rose State College.
I plan to complete my basic coursework at Rose State College and earn a degree at a four-year university.
Non-Degree Seeking (Not Applying for Financial Aid)
I am a student at another college and taking one or more courses to transfer back to that college.
I am taking one or more courses for recreational or personal enrichment purposes.
I am taking one or more specific courses to help build and improve my job skills.
FOR OFFICIAL USE ONLY
Disclaimer Statement
Rose State College is accredited by The Higher Learning Commission: A Commission of the North Central Association of Colleges and Schools, 230 South LaSalle Street,
Suite 7-500, Chicago, IL 60604-1411, Telephone: 1-800-621-7440. Rose State College does not discriminate on the basis of race, color, sex, age, national origin, religion,
disability, genetic information, sexual orientation, or status as a veteran in any of its policies, practices, or procedures. This includes, but is not limited to: admissions,
employment, financial aid, and educational programs, activities, or services. If discrimination, including harassment or retaliation, occurs, the College will take prompt and
appropriate corrective and remedial action. The person designated to handle inquiries regarding the nondiscrimination policies, including issues of noncompliance, is the Senior
Director, Human Resources/Affirmative Action Officer, 6420 SE 15th Street, ADM Room 104, Midwest City, OK 73110, (405) 733-7979. This publication is issued by Rose State
College, as authorized by the Board of Regents. 10,000 copies have been printed by Impressions Printing and distributed at a cost of $928.43.
DOCUMENTATION OF
STUDENT VACCINATION STATUS
Rose State College is committed to protecting the health of its students. Therefore, the
submission of the following information is being required of all new students who will be
attending classes on-campus.
Please check one of the following:
I hereby certify that I have received the vaccinations for measles, mumps, rubella
and hepatitis B.
I hereby certify that I have received vaccinations for measles, mumps and rubella
and will complete vaccinations for hepatitis B within 6 months.
I hereby certify that the administration of the vaccines for measles, mumps,
rubella and hepatitis B conflict with my moral or religious tenets. (In the case of
a minor, this must be certified by a parent or legal guardian.)
I am submitting below a physician’s statement indicating it is medically
inadvisable for me to take these vaccinations.
I belong to one of the groups of students listed under the Exemptions portion of
this form, and have identified the group to which I belong.
The information provided in this document is true and accurate to the best of my
ability. I understand that falsification of this document is a violation of the Student
Conduct code and such conduct could result in suspension or expulsion from Rose
State College.
________________________________ ________________________________
Student Name Student ID#
________________________________________ __________________
Signature of Student, parent, or legal guardian Date
PHYSICIAN’S STATEMENT
I hereby certify that the administration of the vaccines for measles, mumps, rubella and
hepatitis B are medically inadvisable for the above named student.
_________________________________________ __________________
Signature of Licensed Physician Date
EXEMPTIONS
Certain groups of students will not be asked to provide vaccination information. Please
indicate if you belong to any of the following groups.
I am a high school graduate and that I graduated from an Oklahoma high school
since 1996.
I am transferring from another college located in the State of Oklahoma.
I am only enrolling in off campus or distance education courses.
I am active military.
I am enrolling in Training Center classes only.
I graduated from a high school that required these vaccinations. State of high
school graduation: _____________________Year of Graduation _____________
I have been provisionally admitted and will take no more that 9 credit hours at
this institution until I have submitted the above information and been admitted as
a regular student.
If my status at this institution changes so that the above claimed exemption no
longer exists, I understand it is my responsibility to notify the institution of these
changes and to provide my vaccination information before I enroll in additional
course.
____________________________________ ____________________
Student Signature Date
Return the completed form to:
Rose State College
Office of Admissions and Records
6420 S.E. 15
th
Street
Midwest City, OK 73110
INTERNATIONAL STUDENT FINANCIAL VERIFICATION
Office of Admissions and Records
6420 S. E. 15
th
Street
Midwest City, Oklahoma 73110-2799
F-1 international students are required to show documentation proving that sufficient financial resources are available to pay for
educational and living expenses while studying in the U.S., according to United States Citizenship and Immigration Service
(USCIS). You should plan on having extra funds available for things such as travel back to your country or to stay in the United
States during the summer months, as summer costs are not shown in the estimated expenses below. Tuition costs are estimated
and subject to change by the Oklahoma State Regents for Higher Education. A Certificate of Eligibility (I-20) will not be issued
without valid proof of financial resources. Financial documents must be certified originals that are less than 90 days old.
Estimated Expenses
(Based on 12 credit hours per semester for Fall and Spring):
Tuition and Fees .............................................................................................................................. $8,300.00
Books and Supplies ........................................................................................................................... 1,100.00
Living Expenses (based on current campus housing costs) .............................................................. 8,600.00
TOTAL COSTS .......................................................................................................................... $18,000.00
• $2,500.00 in additional funds must be shown for each dependent spouse, and $2,500 for each dependent
child that will be coming with you.
• Students may need to rent an apartment within the Midwest City area or in nearby Oklahoma City.
Location of a student’s housing may affect transportation costs. On campus housing is also available, but
there are a limited number of rooms and space is not guaranteed. Students must apply for on campus
housing separately. Information is available on our website.
• All international students are required to purchase and maintain Health and Repatriation Insurance.
The cost will be determined by the insurance company and policy plan the student chooses.
Applicant’s Name: _________________________________ _________________________________ _____________________
(please print) Last (Family) First (Given) Middle
Please list additional dependent family members coming with the applicant to the U.S. during period of study:
Dependent 1 Dependent 2 Dependent 3 Dependent 4
Last (Family) Name _________________ _________________ _________________ _________________
First (Given) Name _________________ _________________ _________________ _________________
Date of Birth _________________ _________________ _________________ _________________
Birth Country _________________ _________________ _________________ _________________
Citizenship Country _________________ _________________ _________________ _________________
Relationship _________________ _________________ _________________ _________________
All funds that I am responsible for will be provided by (check one):
____ Family ____ Self ____ Other (please specify):___________________________
I understand that these are estimated expenses that may change at any time. I also understand that tuition is due at the
beginning of every semester. I certify that I will have sufficient funds to pay for my actual expenses for each year that I
attend Rose State College.
Applicant’s Signature: ___________________________________________________ Date: ________________
INTERNATIONAL STUDENT SPONSOR SUPPORT CERTIFICATION
Office of Admissions and Records
6420 S. E. 15
th
Street
Midwest City, Oklahoma 73110-2799
• A CERTIFIED BANK STATEMENT FROM YOUR SPONSOR’S BANK SHOWING AVAILABLE FUNDS TO COVER
EXPENSES FOR ONE YEAR MUST BE ATTACHED.
• THE BANK STATEMENT MUST BE LESS THAN 90 DAYS OLD.
• THE BANK STATEMENT MUST INCLUDE A TRANSLATION TO U. S. DOLLAR
EQUIVALENCY.
• THE BANK STATEMENT MUST BE STAMPED AND SIGNED BY A BANK OR GOVERNMENT
OFFICIAL.
• THE SPONSOR NAME ON THE CERTIFICATE OF SUPPORT MUST MATCH THE NAME ON THE BANK
STATEMENT.
• IF BANK POLICIES DO NOT ALLOW COMPLETION OF THIS FORM, A SEPARATE LETTER OR AFFIDAVIT IS
ACCEPTABLE. IT SHOULD STATE THAT THE SPONSOR HAS AT LEAST THE REQUIRED AMOUNT OF FUNDS
AVAILABLE.
• THE SPONSOR CANNOT BE ANOTHER INTERNATIONAL STUDENT.
SPONSOR’S VERIFICATION OF SUPPORT
This certifies that I, _______________________________________________________, will assume full responsibility for the
SPONSOR’S PRINTED NAME
financial support of ____________________________________________ during his/her studies at Rose State College and have
STUDENT NAME
the equivalent of $18,000 or more in U.S. funds available.
____________________________________________________ ______________
SPONSOR’S SIGNATURE DATE
SPONSOR’S RELATIONSHIP TO STUDENT: _________________________________
SPONSOR’S ADDRESS: ____________________________________________________________________________________________
I certify that the above mentioned person has sufficient funds necessary to cover the above listed estimated costs of attendance at
Rose State College. This does not include finances for the care of a spouse or children.
___________________________________________________________________
SIGNATURE & TITLE OF BANK OR GOVERNMENT OFFICIAL
_________________________
DATE
SEAL OR STAMP
CERTIFICATION
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signature
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Sample Bank Letter
(Must be printed on official bank letterhead paper, and have an original bank
official’s signature and the bank’s official stamp or seal on the letter)
Date of letter
(Must have been printed within the past 90 days)
(Sponsor’s name
), (relation to student) of (student’s name), is an account holder in
good standing at (Name of Bank
). According to our institution’s records, he/she is
capable of supplying funds to pay for all of (student’s name
)’s educational and living
expenses while he/she is an enrolled student at Rose State College.
This letter should serve as verification from our institution that (sponsor’s name
) has a
(type of account
) containing available funds totaling (local currency). This amount is
equal to (the equivalent amount in U.S. dollars
) in U.S. currency.
I certify that the information contained in this letter is true and correct.
Sincerely,
Signature of Bank Official
(Bank’s Official Stamp or Seal here)
Name and Title of Bank Official
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Completed 3 October 2020

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