Los Angeles Harbor College International Student Application

Name (as in passport):

Last/Family Name ______First Name ______Middle Name ______

Email Address (required) ______Telephone # ______Date of Birth (mm/dd/yyyy) ______

Country of Birth ______Country of Citizenship ______

Male □ Female □ Will dependents(spouse/children) accompany you? □ Yes □ No (If yes, list below)

Last/Family Name ______First Name ______Middle Name ______

Country of Birth ______□Male □ Female Relationship ______Birth date ______

Last/Family Name ______First Name ______Middle Name ______

Country of Birth ______□ Male □ Female Relationship ______Birth date ______

Last/Family Name ______First Name ______Middle Name ______

Country of Birth ______□ Male □ Female Relationship ______Birth date ______

Home Country Address (required):

Number & Street ______Apt. #______City______

State/Province ______Postal Code ______Country ______

U.S. MailingAddress (if any):

Number & Street ______Apt. #______City______

State/Province ______Postal Code ______Country ______

Are you in the U.S. currently? □Yes □ No If yes, telephone number ______

If yes, your visa status? □ F-1 □ Other (identify): ______□ No Visa (outside U.S.)

Term you plan to start:□ Fall (August/September) 20 ____ □ Spring (February) 20___

Where should we send your I-20 and acceptance letter?

□ Home country address □ U.S. mailing address □ Will pick up

□ Other ______

Emergency Contact in U.S. or Home Country:

Name ______Relationship ______

Address ______Telephone Number ______

How did you learn about Los Angeles Harbor College?

□ Friend/Relative (Name) ______□ Language School ______

□ U.S. Embassy/Consulate/Advising Center □ StudyUSA.com

□ StudyinCalifornia.com □ Other ______

EDUCATION

Have you completed or if still attending, will you complete high school before starting you program at Los Angeles Harbor College? □ Yes □ No Completion date ______

Are you currently studying at a school or college in the United States? □ Yes □No

If in U.S., will you leave the U.S. before coming to LAHC? □ Yes □ No

List secondary/high school and language schools, colleges and universities you have attended.

Name of School Location Attendance Dates (mm/yyyy) Graduated/Completed
From To
□ Yes □ No
□ Yes □ No
□ Yes □ No

Intended Major Field of Study ______

Educational Goal at LAHC:

□ Associate (two-year) Degree or transfer toa 4-year college/university

□ Career Certificate (one year) □Other (explain) ______

(Circle one below)

TOEFL (iBT CBT PBT) IELTS TOEIC Eiken Date Taken ______Score ______(Waived if secondary education was carried out in the medium of English)

What are your plans after completing your program of study and (if possible) work experience in the U.S.? ______

FINANCIAL STATEMENT:

How much money will you receive while you are studying in United States? I will receive (U.S.dollars) $______per month for a total of $ ______per year while studying in the U.S.

(Note: The amount you receive must be equal to at least $15,226 for your first year.)

In addition to the Affidavit of Support, I have attached one of the following original financial documents: □ Bank Statement □ Letter from Bank □ Income Tax Returns

□ Other appropriate document (identify) ______

(Note: Bring original copies of financial document(s) to U.S. Embassy for your interview.)

In signing this document, I declare that the above statements are accurate and complete to the best of my knowledge.

Signature:______Date:______