International Student Supplemental Information
Attach Photo Here
For office use only:
ID# ________________
Semester ___________
Family/Last Name
Given/First Name
Date of Birth (mm/dd/yyyy)
Country of Birth
Country of Citizenship
Gender
First Language
Email Address
I am (check one)
Planning to enter/re-enter the U.S. with an F-1 student visa.
Currently living in the U.S. and attending school in F-1 student status (Transfer-In Student).
Currently living in the U.S. with the following visa status: _________ and will request a Change of Status to F-1.
Home Country Address and Phone Number
(U.S. regulations require international students to submit an address outside the United States)
If applicable -- Contact Person in the U.S. (address and phone number)
Name:
Address:
Phone #:
Email:
Street and Number
Additional Street Information
City/Town
State/Province
Postal Code
Country
Telephone Number
English Proficiency/Major -- Attach proof of scores
TOEFL iBT 79 or IELTS 6.5 or passed English 101 at an accredited U.S. college/university)
I will study the following major:
Financial Information (submit a bank certificate or letter, dated within the previous six months)
I am self-sponsoring
Amount of Funds in USD:
Signature, Name, and Date
Signature:
Name:
Date:
I have a
sponsor/sponsors
Amount of Funds in USD
Sponsor (s) Signature, Name, and Date
Signature:
Name:
Relationship to
student:
Date:
Responsibility Acknowledgement
I will attend the mandatory orientation session prior to my first semester at Harper College.
I understand I am required to enroll in the school insurance for international students and I will be charged a health
insurance premium each semester at registration.
I will report a change of my address to the international student coordinator within ten (10) days of moving.
I understand I must register full-time (minimum of 12 credits) every fall and spring semester.
I understand that I am expected to show successful completion of coursework each semester.
B
y signing my name below, I confirm the accuracy of the information I have provided above and accept responsibility for
maintaining my legal F-1 status.
A
pplicant Signature: _______________________________________________________ Date: __________________
Save this form to your computer, fill it out and email the filled out form to: iso@harpercollege.edu