EVERGREEN VALLEY COLLEGE INTERNATIONAL STUDENT PROGRAM

International Student Program Application Packet Applicant’s Name: Applicant Number: Intended Starting Term: Telephone: Email:

International Student Program Evergreen Valley College 3095 Yerba Buena Road, San Jose, CA 95135 Tel: 001.408.223.6740 Fax: 001.408.223.9351 [email protected]

www.evc.edu/future-students/admissions-and-records/international-students

EVC International Student Application Revised 06/25/2014

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International Programs & Services Office Tel: 001.408. 223.6740 Fax: 001.408.223.9351 [email protected]

Evergreen Valley College 3095 Yerba Buena Road, San Jose, CA 95135 www.evc.edu

Evergreen Valley

College

International Student Application Checklist It is the applicant’s responsibility to check if all documents required are complete and sign this checklist. Applicants should be aware that incomplete application WILL delay the admission process. Applicant’s Name (Print): ______________________________________________________ 1. International (F-1) Student Application 2. EVC College Application Note: for the above forms, all requested information must be filled out completely, and a U.S. address must be provided for SEVIS, as required by USCIS. 3. Official Transcripts from your high school/colleges 4. TOEFL or IELTS, scores MUST be sent directly by testing agency. School code: 4273, Department code: 00 • • •

TOEFL: Minimum score based on test type: 500 – paper based exam; 173 – computer based exam; 61 –Internet based exam. IELTS: Minimum Band Score: 6.0 If the applicant has completed degree applicable courses in English with a grade of “C” or better (at an accredited U.S. college/university), the TOEFL or IELTS may be waived.

5. Original Bank Verification (signed by certifying official) with minimum balance of US$20,000 from parent(s) or sponsor dated within 6 months of application date. 6. Letter of Financial Support or Affidavit of Support form from a parent or a sponsor 7. Copy of passport (biographical information page) 8. TB Skin Test results. If results are positive, a chest x-ray will be required. Exams must be dated within 6 months of application date. If applying for admissions in the U.S., in addition to the above-listed, the following items are also required: 9. Copy of your current visa, Information pages and I-94 Card from your passport 10. If you are currently on an F-1 Student Visa: i. ii. iii.

Copy of your Form 1-20 Transcripts from current school Transfer authorization letter from current school (may be provided upon acceptance)

I hereby confirm that I have included all above listed items in my application. Signature of Applicant: ___________________________

EVC International Student Application Revised 06/25/2014

Date: _____________________

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International Programs & Services Office Evergreen Valley College 3095 Yerba Buena Road, San Jose, CA 95135 Tel: 001.408. 223.6740 Fax: 001.408.223.9351 [email protected]

I am applying for:

Evergreen Valley

FALL 20_________

College

Spring 20________

International (F-1) Student Application

NAME Last (Family) as appears in your Passport Date of Birth (mm/dd/yy)

Female

Country of Birth

First (Given)

Middle

Male

Primary Language

Country of Citizenship

Degree / Program of Study (to view a complete listing, visit: www.evc.edu/academics/degrees-certificates-and-employment/degrees-certificates Home Country – Permanent Address:

Local/ U.S. Address (not a P.O. Box):

Number and Street

Number and Street

City

City

State/Province/Prefecture

State/Province/Prefecture

Country

Postal Code

Cell /Tel # (include country code)

Country

Postal Code

Cell /Tel # (include country code)

Preferred E-Mail Address

Where would you like your I-20 and acceptance letter mailed? Home/Permanent

Local/Current

Check one box only

Agency name:

Other, shown below: Contact Person

Complete Address

Phone # & E-mail Address EVC International Student Application Revised 06/25/2014

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MARITAL STATUS:

Single

Married

Will Spouse/Children Accompany you to the U.S?

YES (additional documentation/finances will be required)

Name

NO

Relationship to Applicant

If you are in the U.S. now, please indicate your current visa type: ________________________________________ Date of entry into the U.S.: _____ / _____ / ______ Month

Day

Visa Expiration Date: _____ / _____ / _______

Year

Month

If you don’t have F-1 visa, where will you be applying for it?

Within the U.S.

Day

Year

From your home country

If currently on an F-1 visa, what institution issued your Form I-20? ________________________________ ENGLISH PROFICIENCY: TOEFL Test __________ (score) Test Date:

IELTS Test _________ (score)

_____ / _____ / ______ Month

Day

Test Date:

Year

______ / _____ / ______ Month

Day

Year

Waived, due to EDUCATIONAL BACKGROUND: (please list your high school and any college attended)

High school Attended

City/Country

Date Completed

University/College Attended (If any)

City/Country

Date Completed

Diploma

Diploma/Degree

TO BE COMPLETED BY STUDENTS CURRENTLY STUDYING IN THE UNITED STATES ONLY Name of U.S. school you are currently attending

City/State

Date Started

REFERRAL SOURCE/AGENT INFORMATION How did you learn about Evergreen Valley College (EVC)? EVC website

Friends/Relative

Counseling agency

Fair/Seminar

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If the application is submitted by an education advising agency, please complete the following: Agency Name: _______________________________________

Contact Person’s Name: ___________________________

Email Address: ________________________________________

Phone Number: __________________________________

Address: _______________________________________________________________________________________________________

EVC International Student Application Revised 06/25/2014

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EMERGENCY CONTACT INFORMATION This information will remain on file for the duration of your enrolment. If a change occurs, please report to the International Programs & Services Office IMMEDIATELY. Emergency Contact Person: ______________________________________________________________________ Address: ____________________________________________________________________________________ Telephone Number: ___________________________________ Mobile Number: __________________________ (include country code)

(include country code)

E-mail: ________________________________________________ Relationship to Applicant: _________________________________ Does this person speak English?

YES

NO

As an International (F-1) Student attending Evergreen Valley College, I understand that I am encouraged to participate in a supplemental medical/emergency plan (to purchase and carry medical insurance). If I choose do not participate, I assume personal liability for any accident, health, hospitalization and any/all other medical related expenses incurred by me while attending EVC as an International Student. By signing this application, I am accepting all responsibility for my medical care and expenses. Evergreen Valley College does not accept potential applicants that have been dismissed or terminated from other U.S. collegiate institutions for any reason. I hereby declare that I have never been dismissed or terminated by any other U.S. collegiate institution. If accepted to EVC, I will follow the Standards of Student Conduct and Compliance with U.S. Immigration Laws & Regulations: The Role and Responsibility of the International Student that are published in the college catalog and website respectively, and I understand that failure to do so would be grounds for dismissal. I understand that, upon acceptance and arrival at EVC, students will be tested for English and Math proficiency in order to be placed at appropriate course level. All classes are conducted entirely in English; therefore students without sufficient placement may be referred to a language school/program until they are able to meet the standards necessary to successfully complete the required courses for their educational program. THE STATEMENTS MADE BY ME IN THIS APPLICATION ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWEDGE. I UNDERSTAND THAT ANY FALSIFICATION CONSTITUTES PERJURY AND MAY BE LEGAL BASIS FOR DISMISSAL

Student Name (please Print)

Student Signature

EVC International Student Application Revised 06/25/2014

Date

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