International Students Application Form

Student Information

Last/Family Name:
First/Given Name:
Middle Name:
Gender:Male Female
Date of Birth (mo/day/year):
(example: 3/25/1988 for 25 March 1988)
Are you currently in the US? Yes No
If yes – what is your immigration status (e.g. F-1)
Country of Birth:
City of Birth:
Country of Citizenship:
Native Language:
Student Email Address:
Agent Email Address (optional):
Permanent Home Address (as would appear on an envelope):
Current Mailing Address (as would appear on an envelope):
Current Mailing Address - Is this Your Address Or Agent's Address
Home Telephone Number:
Other or Agent Telephone Number:

Language Requirements

I plan to study at IIE. If checked, do not fill in Language Test Information.
I am a native speaker of English. If checked, do not fill in Language Test Information.
I have other evidence of English language proficiency.

Language Test Information

I have taken an English language test (for acceptable scores please see English Language Requirements).

Type: Date (must be within the last 2 years):

I will take an English language test:

Type: Date:

Programs

IIE (ESL program).
Associate degree (2 year)
Bachelor degree (4 year)
Intended Major:
Second Major (optional):
Minor (optional):

Academic Requirements

(Check all that apply):
I am applying directly from secondary school or I have less than 14 transferable credits of post-secondary study.
I have completed high school with at least a 2.0 Grade Point Average (GPA) on a 4.0 scale.
I have an SAT/ACT Score. Score: Date:
I have a GED.
I am a transfer student from a US or non-US school.
I am a GAC student. GAC identity number:

Education

If IIE checked do not fill in this information.
Not needed if studying at IIE only.
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.
Name of school:
City, Country:
Dates attended:
Graduation Date:
Degree/Number of credits earned:

International Athletes

Check if interested in applying for an athletic scholarship.
Tennis Golf Cross Country Track
Baseball Volleyball (woman’s) Basketball

Intended Starting Date

IIE start date: How many IIE 8-week terms:
LCSC Start - Fall Spring Year:

Housing

Homestay
LCSC Residential Halls
Private rentals/shared accommodation

How did you find out about LCSC/IIE?

Agent
Internet
Fair
Relative/Friend
School/Counselor
Other.
If other, please explain

Additional Comments