International Student Admission Application

International Student Admission Application Dear Prospective International Student: Thank you for your interest in Century College, a two-year college...
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International Student Admission Application Dear Prospective International Student: Thank you for your interest in Century College, a two-year college with over 12,000 students, located in White Bear Lake, Minnesota, a suburban community located about 10 miles north of the state capital, Saint Paul. White Bear Lake has a population of 26,000, and is part of Twin Cities (Minneapolis-St. Paul) metro, which includes over 3,250,000 residents. Century College offers over 40 programs of study leading to two-year Associate Degrees in Arts, Sciences, or Applied Sciences. Century also offers courses that allow students to complete the general education courses of a wide range of majors, transferable to four-year colleges and universities. The academic year is divided into two semesters, during which an international student must be enrolled full time with 12 or more credits, usually taking three to four different courses each semester. The fall semester runs from late August through midDecember and the spring semester runs from mid-January to mid-May. Minnesota’s climate includes all four seasons. The weather ranges from 21 to 32 degrees centigrade (June through August), and -6 to-12 degrees centigrade (December through February). Century College offers many opportunities for involvement through our Student Life activities, as well as our Intramurals and Athletics programs. You can learn more about Century College by visiting Century College’s vision is to be a national leader in transforming lives through an innovative, rigorous, and compassionate approach to education. Its mission is to inspire, prepare, and empower students to succeed in a changing world. I am sure you will find Century College to be an excellent choice at which to pursue your educational goals and to experience the Minnesota lifestyle. I look forward to welcoming you to our campus. Sincerely, International Student Admissions Century College 3300 Century Avenue North, West Campus White Bear Lake, MN 55110 USA phone: 651.773.1793 toll free: 1.800.228.1978 ext. 1793 fax: 651.747.4053 [email protected]

Century College is an equal opportunity, affirmative action employer and educator, and a member of the Minnesota State College and University system. This document can be made available in alternative formats to individuals with disabilities by calling 651-779-3354 or MN Relay Service 1-800-627-3529.

Application Deadlines All required documentation MUST BE RECEIVED in the Admissions Office BY THE DEADLINE dates listed below. Late arrivals will be considered for the following semester.

Academic Terms Fall Semester 2016 Spring Semester 2017 Fall Semester 2017 Spring Semester 2018

Arrive By August 15 January 2 August 14 January 1

Begins On August 22 January 9 August 21 January 8

Ends On December 15, 2016 May 11, 2016 December 14, 2016 May 10, 2018

**Application Deadlines** From Outside U.S. Inside U.S. Transfers May 1, 2016 July 1, 2016 October 1, 2016 December 1, 2016 May 1, 2017 July 1, 2017 October 1, 2017 December 1, 2017

Who should use the International Student Application?  Foreign students living abroad who wish to receive an I-20 Form to study as a full time student.  Non-immigrant aliens currently in the US, with any type of visa, who wish to change their visa status to F-1. Additional documentation will need to be submitted to the Immigration Service.  Non-immigrant aliens currently in the US with visas such as B, F, H, J, K, TPS, and etc., and applicants for political asylum. If you are not trying to change your current visa to a student visa, please submit all application materials except the Financial Responsibility Form, bank documents, and International Student Agreement Form. Those having B-1/B-2 and F-2 visa status must apply for a change of non-immigrant visa status through the U.S. Immigration Service, and must have approval of their visa status change prior to registering for any courses. United States Citizens, Permanent Residents, Refugees, Approved Asylees, and Undocumented Individuals should apply with the standard new student application online at

SPECIAL APPLICATIONS, PREREQUISITES, and HIGH DEMAND PROGRAMS Due to the high demand for the career programs listed below, Century College cannot guarantee that you will be able to start in your intended career program immediately upon admission to Century College. In some cases, students’ academic plans will need to change, due to limited openings in certain career programs. Special application forms and/or processes are required for the following programs:     

Dental Assisting and Dental Hygiene Kitchen and Bath Design Certification (on-line) Medical Assistant Nursing Orthotic Technician and Orthotic Practitioner

   

Orthotic and Prosthetic Clinical Applications Paramedic Prosthetic Technician and Prosthetic Practitioner Radiologic Technology

ENGLISH PROFICIENCY REQUIREMENTS FOR ADMISSION Century College requires the following minimum English proficiency scores for admission: TOEFL Internet Based Test (iBT) – 61 TOEFL Paper & Pencil Based Test – 500 IELTS Test - 5.5 Century College’s Accuplacer-ESL Test – placement into ESOL 0020 level courses or higher Century College assessment testing is required for all new students at the college to receive course placements and complete course registration. Students may receive placement into ESOL, pre-college, or college-level courses. Completion of ESOL and pre-college courses is generally required before students can register in courses of his or her intended degree program. ESOL and pre-college courses are numbered below 1000 and provide credits to satisfy visa fulltime enrollment requirements, but do not provide credits toward graduation or college transfer. Assessment testing must be taken upon students’ arrival on campus.

International Student Admission Application (Page 1 or 3)

INTENDED START DATE: ** Application Deadlines on previous page. [] Fall Semester (year) ______ [] Spring Semester (year) ______ *INTERNATIONAL STUDENT ADMISSION DOES NOT ADMIT F-1 VISA SUMMER SEMESTER START OR TRANSFER.* Have you attended this college before? [] Yes [] No If yes, last year attended: __________________ A non-refundable Application Fee of $20.00 USD, made payable to Century College, is required with this application. Western Union or banks handling international accounts can provide you a check payable in U. S. Dollars. Thank you.

PERSONAL INFORMATION (Print your name clearly, just as it appears on your passport.*) _____________________________________________________ Email Address: ___________________________ Surname/Family Name*

Given/First Name

Middle Name

_______________________________________________________________________________________________________ Home Country Address City State Country Mailing/ZIP Code _______________________________________________________________________________________________________ U. S. Mailing Address City State Mailing/Zip Code ______________________________ Cell Phone Number

__________________________________ Other United States Phone Number

________________________ Birth Date (Month/Day/Year)

______________________________________________________________________________ Gender ( ) Male ( ) Female City of Birth Country of Birth Country of Citizenship Native Language _______-_______-_________ Note: Many colleges/universities use Social Security numbers for student identification purposes on student records. U.S. Soc. Sec. # (optional if available)

Providing your Social Security number is voluntary. If you do not provide this number, your application will still be processed. This data is requested for purposes of administration, program evaluation and consumer and alumni data. Your number may also be used to create summary information about system programs through data matches with other state agencies.

……………………………………………………………………………………………………………………………………… ……. List below family members who will travel with you and have F-2 visa status: 1._________________________________ 2._________________________________ 3.________________________________ Full Name and Relationship

Full Name and Relationship

Full Name and Relationship

VISA INFORMATION ** (Only complete if you are already in the United States) **Attach to this application, copies of passport, visa, BOTH SIDES of I-94 form, and current I-20, if applicable. Specify current visa type: [] B [] F-1 [] F-2 [] H-1 / H-4 [] J-1 []K []R [] Other Classification: _________ Are you seeking to change your visa status to F-1, prior to registering for courses at Century College? Yes ___ No ___


In the United States: ___________________________________________________________________________________________________________________ Name (Last, First, Middle) Relationship Email Address ___________________________________________________________________________________________________________________ Complete Address, City, State, Mailing/Zip Code Telephone Number In your Home Country: ___________________________________________________________________________________________________________________ Name (Last, First, Middle) Relationship Email Address ___________________________________________________________________________________________________________________ Complete Address, City, State, Country, Mailing/Zip Code Telephone Number

EDUCATIONAL GOALS: What is your current educational intent at Century College? Only mark one [] box. [] Complete courses, but not a degree (not an option for F-1 students on I-20’s at Century College) [] Earn an occupational certificate/diploma. Please list program name: ___________________________ (not an option for F-1 students) [] Earn an online Kitchen and Bath Design Certificate (for International Students not seeking I-20 or to travel to United States) [] Earn an Associate in Fine Arts (AFA) Degree in Music and transfer to a four-year college or university to major in: _________________. [] Earn an Associate in Arts (AA) Degree and transfer to a four-year college or university to major in: _____________________________. [] Earn an Associate in Science (AS) Degree in the program circled below: 0540 Business Administration 5109 Computer Science Associate in Services Applied Science 5597 Human 5031 Horticulture Science 5839 Health Sciences Broad Field


5298 Chemical Dependency 5504 Criminal Justice Programs – Circle your 5505 Law Enforcement 5021 Education


5107 Computer Information Systems 5392 Engineering program: 5258 Nursing * 5833 Individualized Studies for Transfer

[] Earn an Associate in Applied Science (AAS) Degree in the program circled below: 5867 3D Animation (VCT) 5030 Accounting 5060 Administrative Assistant 5040 Business Management 5036 Computer Forensics 5598 Cosmetology 5202 Dental Assistant* 5223 Dental Hygiene* 5637 Emergency Med. Services-Paramedic* 5816 Energy Technical Specialist 5391 Engineering CAD Technology

5834 Individualized Studies for Occupation 5313 Facility Systems Technology 5875 Filmmaking & Video Production (VCT) 5873 Graphic Design (VCT) 5322 Heating, Vent. & Air Cond. Tech 5032 Horticulture-Greenhouse 5034 Horticulture-Landscape 5035 Information & Telecommunications 5455 Interior Design 5050 Marketing Management 5052Marketing Communications Tech

5093 Medical Office Assistant 5106 Microcomputer Support Tech 5288 Orthotic Technology* 5020 Para-educator 5883 Professional Photography (VCT) 5289 Prosthetic Technology* 5506 Public Safety 5256 Radiologic Technology* 5025 Translating and Interpreting 5869 Web Design (VCT)

*Special Program Applications and Admission Requirements are needed for acceptance into the following programs: Dental Assistant, Dental Hygiene, Emergency Medical Services - Paramedic Technology, Nursing, Orthotic Technology, Prosthetic Technology, and Radiologic Technology. An application form, separate from that used for admission to Century College, is required.

EDUCATIONAL RECORD: Please list all prior high schools, ESL programs, colleges, and universities that you have attended. Attach to this application, copies of your educational records, along with English translations. Include your high school and all schools, through the most recently attended. If you are seeking a degree, and have transferable foreign college/university credits, please request that your international transcript(s) be sent by your former school(s) directly to a credential evaluation service, such as, World Education Services, Inc. or Educational Credential Evaluators. Once an evaluation service has assessed your transcript(s), a Century College academic counselor can work with you to petition for the satisfaction of specific degree requires, based on your transferable credits. (Page 3 of 3)

Name of your High School, College and/or University

Location of Institution: City and Country

Start Date

Leaving Date

What Certificate/Degree/ or Diploma Received & ->

Month & Year Recv’d

The college is asking you to provide information that includes private and/or confidential information under state and federal law, in order to process your application. You are not legally required to provide this information; however, the college may not be able to effectively process your application if you do not provide sufficient information. With some exceptions, unless you consent to further release of private information, access to this information will be limited to school officials, including faculty who have legitimate educational interests in the information. Under certain circumstances, federal and state laws authorize release of private information without your consent: to schools in which you seek or intend to enroll, or are enrolled, to federal, state or local officials for purposes of program compliance, audit or evaluation, as appropriate in connection with your application for, or receipt of financial aid, to your parents, if your parents claim you as a dependent student for tax purposes, if the information is sought with a subpoena, court order, or otherwise permitted by other state or federal law, and to an organization engaged in educational research or an accrediting agency.

CERTIFICATION: (Your application must be signed and dated) I certify that the information I have provided on this application and all other materials are complete, accurate and true to the best of my knowledge. I understand that is my responsibility to request that official transcripts from each academic institution I have attended be sent directly to Century College. As a student in a public institution, I understand that my photo may be taken in a group setting, classroom or large group gathering for promotional purposes.

Applicant’s Signature:______________________________________________________

Date: _______________________________________


REQUEST FOR CONFIDENTIAL INFORMATION, not required for admission purposes: Providing the following information is voluntary. This information will assist Minnesota State Colleges and Universities in evaluating student recruitment and retention policies. It will not be used as a basis for admission. Are you Hispanic or Latino? (a person of Cuban, Mexican, Chicano, Puerto Rican, South or Central America, or other Spanish culture, regardless of race)? [] yes [] no Race and ethnic background (select any that apply) [] American Indian or Alaska Native – A person having origins in any of the original peoples of North, Central or South America and who maintains tribal affiliation or community attachment [] Asian – A person having origins in any of the original peoples of the Far East, Southeast Asia or the Indian subcontinent [] Black or African American – A person having origins in any of the black racial groups of Africa [] Native Hawaiian or Other Pacific Islander – A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands [] White – A person having origins in any of the original peoples of Europe, the Middle East or North Africa What is the highest level of education for your parent (s)/guardian(s)? Please respond for the parent(s), step-parent(s), adoptive parent(s) or guardian(s) who raised you. Check only one box for each parent/guardian. Parent/Guardian #1 [] No high school diploma [] High school diploma [] Some college [] Two-year college degree/diploma [] Bachelor’s degree or higher [] Don’t know Parent/Guardian #2 [] No high school diploma [] High school diploma [] Some college [] Two-year college degree/diploma [] Bachelor’s degree or higher [] Don’t know

International Student Agreement Please sign and submit this agreement with your application.

If admitted to Century College, I agree to: 

Maintain my status with respect to United States Citizenship and Immigration Service (USCIS) regulations and Minnesota State Colleges and Universities policy for the duration of my studies at Century College. F-1 visa status students must: 1. Be enrolled as a full-time student for 12 or more credits during Fall and Spring semesters. 2. Not be employed outside of Century College campus without proper authorization from Century College and/or USCIS. 3. Purchase the Minnesota State Colleges and Universities’ health insurance plan or maintain health insurance during enrollment. ** 4. Maintain a valid passport and from I-20 at all times. ** Students must maintain health insurance coverage throughout the duration of their attendance at Century College. Student coverage will be re-verified every year. It is the student’s responsibility to make sure insurance is renewed every year of attendance. Century College reserves the right to suspend students who do not comply with this mandatory insurance requirement. Century College assumes no responsibility for medical expenses.

Abide by Century College policies and procedures as they apply to student conduct and academic progress.

Arrive in time prior to the start date of the semester at Century College in order to complete course placement testing, attend New Student and International Student orientations, and complete course registration.

Complete the Tuberculin Skin Test (TST) at Century College’s Health Services Office during the first semester to determine exposure to tuberculosis. Complete tuberculin follow-up exam and treatment, if recommended. Provide proof of immunizations for measles, mumps and rubella (MMR) and for diphtheria and tetanus (DT).

Have adequate funds to meet all my expenses during my studies at Century College.

Please print your name: _______________________________________________________________________ Last


Your signature: __________________________________________


Date: ____________________

Financial Responsibility Form

(Page 1 of 2)

You must complete the reverse side of this statement and return it with your application. Please attach required bank documentation(s) along with required official stamps or seals noting that your identity was verified when signing this form. Century College requires certification of adequate financial support from applicants with non-immigrant visas. The certification statement on the next page must be on file at Century College before admission will be considered. A student must be prepared to pay for his/her first semester tuition and fees, books and supplies, and the annual injury and sickness insurance costs, immediately upon arriving at Century College. Financial aid is not available to international students.

ESTIMATED COSTS FOR ATTENDANCE AND LIVING EXPENSIVES* * Tuition and fees are set by the Minnesota State Colleges and Universities Board of Trustees each July, preceding the academic year. Costs listed below are subject to change. Current tuition and fees are on the college’s website, at Amounts shown below are in USDs.


Estimated Full Year Cost for: 2016-17

Tuition and fees * (12 credits x 2 semesters x $ Rate) Books, supplies, and fees ** (2 semesters) Injury & Sickness Insurance *** (12 months) Room and Board/Food Transportation Miscellaneous/Personal Expenses If including a spouse as F-2 dependent If including a child as F-2 dependent


{Rate $190} = $4,560 {Rate $190} = $4,560 1,400 1,400 1,400 1,400 9,400 9,500 2,000 2,000 3,000 3,000 TOTAL $21,760 $21,860 $3,500 $3,500 $2,500 (per child) $2,500

Century College does not provide campus housing or make living arrangements for students. Students are responsible for arranging their own living and transportation accommodations prior to arriving to the college. * Tuition rates are generally higher by $20 per credit for on-line courses, by $35 per credit for Nursing discipline courses, and by $26 per credit for Dental Assisting & Hygiene, Orthotic Technician & Practitioner, and Prosthetic Technician & Practitioner discipline courses. Shown above is the rate for the minimum credit registration required during Fall and Spring Semesters (12+12=24 credits) in general academic discipline courses, including those within the discipline of English for Speakers of Other Languages (ESOL), and those courses numbered below 1000 and considered pre-college level or developmental level. Students often register for more than the minimum number credits during Fall and Spring semesters, and also take Summer Session courses, thus increasing expenses for tuition, fees, books, and supplies beyond the above estimated costs. ** Tools and materials in trade/technical programs can cost up to $3500, and are the student’s responsibility. *** Injury and Sickness Insurance is required, and needs to be paid for each year prior to course registration. Century College offers a health insurance policy for students to purchase with UnitedHealthcare. Prices for the policy is subject to change each academic year. Single students must provide evidence of minimum financial support in the amounts shown above to meet expenses for one calendar year in the United States. If applicable, an Affidavit of Support form, USCIS Form I-134, available at, can be completed to provide evidence of support for Room and Board, Transportation, and Miscellaneous/Personal Expenses, which composes the majority of the total annual costs, leaving the remainder to be covered by banking documents. Student who cannot demonstrate that they have sufficient funds will not be admitted to the college.

*Applicant and Financial Sponsor must sign this form and submit supporting financial documents.

Financial Responsibility Form

(Page 2 of 2)

By signing this form, the student affirms that: 1. I will have sufficient funds available to pay all of my necessary expenses in the amount indicated on the reverse side of this form for the duration of my studies at Century College and will further be able to pay for travel to and from my home country. 2. I understand that I will not receive financial aid (grants, loans, or employment) from the college. 3. The source(s) of my supporting funds, listed below, are shown in US dollars: Source of Funds: mark with “X’ all that apply

Required Supporting Documents Amount in US Dollars

___ Personal funds/self supporting

Bank statement


___ Parents/family: Relationship_________________________

Bank statement


___ Sponsor support: Name_____________________________

Bank statement


___ Your government (Specify name) ____________________

Signed copy of the award letter


___ Scholarship:______________________________________

Signed letter with details of award


___ Other: Name_____________________________________

Affidavit of Support: Form I-134 and supporting evidence, see




(Total must equal at least the minimum estimated annual amount)



(For students with dependents)

**If you are including other dependents staying in the US, you must include $3,500 for your spouse and $2,500 for each child in your minimum total. CERTIFICATION OF SUPPORTING FUNDS: ** SPONSOR CONTRIBUTING THE LARGEST AMOUNT MUST SIGN I, __________________________________________________, have agreed to financially support the student named on this application. (Print Sponsor’s Name)

I have presented true and accurate information to demonstrate my financial ability to support the education and/or living expenses of the student named on this application to attend Century College. I have agreed for Century College to contact me regarding the education and/or living expenses of the student named on this application. Sponsor’s Signature: ___________________________________________________________________________________________________________ Date: ______________________________________ Relationship to Student: __________________________________________________________ ** STUDENT MUST SIGN THIS SECTION I certified that I have presented true and accurate information on this form, and funds will be available for education and living expenses for me to study at Century College. I understand that any misrepresentation may be cause for denial of my admission to Century College. Student’s Name: ______________________________________________________________________________________________________________ Student’s Signature: ___________________________________________________________________________________________________________ Date: ______________________________________ Relationship to Sponsor: __________________________________________________________

Century Community and Technical College

Transfer Eligibility Form



F-1 students complete Section #1 of this form and then have your current school’s International Advisor (Designated School Official) complete Section #2.

Print name: _______________________________________________________ Birth Date: ________________ Last



Month /Day /Year

I, (your signature) _____________________________________________ authorize the International Student Advisor (or Designated School Official) at _______________________________________________ to provide to Current or previous college/university/ESL program

Century College the information requested in Section #2 below.


International Student Advisor (Designated School Official), please complete A-E below; and then, fax, mail, or email completed form to Century College.

Above Student’s SEVIS ID Number: ___________________________________________ A. The above student: [] Is currently enrolled full-time at this school during term/year__________, which ends on___________ [] Is enrolled less than full-time at this school because_________________________________________ [] Has completed his/her program of study at this school on (date) _______________________________ [] Did not complete his/her program of study. Last known date of attendance was __________________ [] Never reported to this school, as per I-20 issued to student. B. Is the above named student currently serving an ACADEMIC SUSPENSION at your institution? [] No [] Yes C. Has the above named student met all financial obligations to your institution? [] No [] Yes D. To the best of my knowledge, the above student is: [] In status with respect to Immigration and Naturalization Service regulations [] Out of status with respect to immigration regulations because: ________________________________ _________________________________________________________________________________ and [] A reinstatement for student status is pending [] Student has been advised that a reinstatement will be required by his/her new school E. _____________________________________________________________________________________ Name of School


_____________________________________________________________________________________________ Officials Printed Name Signature Telephone _____________________________________________________ Email address

Fax, Mail or Email form to:

_______________________ Today’s Date

International Admissions Century College 3300 Century Avenue North, West Campus White Bear Lake, MN USA 55110 phone: 651.779.1793 or 1.800.228.1978 x1793 fax 651.747.4053 [email protected]

Application Checklist for International Students Applicants seeking an I-20 Form for an F-1 student visa, need to complete items A-O below. Applicants having J, H, L and other non-immigrant visas, complete only items A-E and L-O. If you have questions, please contact the International Student Admissions, at 651.773.1793 or [email protected] A.___ International Student Admission Application. Must include home country address and student’s signature. B.___ Application Fee of $20 U.S. dollars. Application Fee is non-refundable. Int’l Bank checks are acceptable. C.___ High school or secondary school diploma/certificate showing date of completion, with English translation. D.___ Optional: Official university/college transcripts can be submitted directly to or for transfer credit/degree evaluation, with Century College designated to receive evaluation results. E.___ Proof of English proficiency. TOEFL or IELTS scores must be sent directly from the testing center. Century College’s school code is 6388. Minimum TOEFL scores are: Internet Based Test - 61 and Paper Test - 500; IELTS’s is 5.5. If you are applying from inside the U.S., you can substitute Century College’s Accuplacer-ESL test for the TOFEL or IELTS test. ……………………………………………………………………………………………………………………………………………………………………………… F.___ International Student Agreement Form, with student’s original signature. G.___ Financial Statement Form with both Financial Sponsor’s and Student’s signatures notarized or certified. H.___ Supporting bank and/or or other financial documents. Documents must be certified originals or certified true copies, and prepared within 90 days of the submission of the application. I.___ If applicable, Transfer Eligibility Form signed by a Designated School Official at current school. J.___ If applicable, Photocopy of Application to Extend/Change/Reinstate Status Form, I-539. K.___ If applicable, Pay $200 USD Student and Exchange Visitor Information System (SEVIS) Form I-901 fee; see SEVIS program information at and fee payment information at …………………………………………………………………………………………………………………………………………………………………………. All students with U.S. visas applying from within the United States must provide the following: L.___ Photocopy of all pages of current I-20 Form, or DS-2019 Form. M.___ Photocopy of the photo page of passport showing passport number and issue & expiration dates. N.___ Photocopy of current US visa. O.___ Photocopy of both sides of current I-94. Please email, mail or bring application and supporting documents to: [email protected] Century College International Student Admissions 3300 Century Avenue North, West Campus White Bear Lake, MN USA 55110