Name:

Last/Family:

First/Given: 

Middle:        

Gender: Male   Female

Date of Birth (mo/day/year):

Marital Status: Married   Single

TOEFL: Date   Score

Country of Birth: 

Country of Citizenship:

Native language:

Home Country Address: (as it would read on an envelope)

Current Mailing Address: (as it would read on an envelope)

Which address do you want us to use in sending correspondence regarding your application?

Home   Current  Agent   Other:

Home Telephone Number: (include area or country code)

Current Telephone Number: (include area or country code)

E-mail:

Housing: Residence Hall  Homestay   None needed  

Airport pick up needed: Yes  No

I plan to enroll: (Please mark the correct boxes)
4 year (LCSC Bachelor's Degree)   2 year (LCSC Associate's Degree)  
1 year (LCSC Certificate)  Non degree (LCSC) 

Start Date-LCSC: Fall (August)   Spring (January)   Summer (June)   

Year:

Intended Major Field of Study: (Refer to the list of majors offered)

First Major

Second Major (optional)

English as a Second Language (IIE)

Number of 8-week IIE Terms:

Year:

Start Date-IIE: Fall 1(Sept)  Fall 2(Nov)  Spring1(Jan)  Spring 2(March)
Summer 1(May)  Summer 2(July) 

List in order of attendance all secondary and post secondary education (high school and college).
Do not omit schools. Each school listed must submit an official transcript. IIE students do not need to submit transcripts.

Name of School:

City, Country:

Dates Attended:

Graduation Date:

Degree/ Number of Credits Earned:
 

Name of School:

City, Country:

Dates Attended:

Graduation Date:

Degree/ Number of Credits Earned:
 

Name of School:

City, Country:

Dates Attended:

Graduation Date:

Degree/ Number of Credits Earned:

How did you learn about LCSC/IIE?

By clicking the submit button below, you certify that all statements you have made in this application are complete and true and that all records are complete and unaltered.