I plan to attend CCC (Campus Location)
Grand Island, Nebraska
First Name/Primary Name
Last Name/Family Name/Surname
Do you plan to bring dependents (spouse or children) with you to CCC? Submit the following information about each dependent below. An I-20 is needed for each dependent. Family housing is not available 1. Full names as shown on passport 2. Relationship to you 3. Gender 4. Date of birth 5. Country of birth 6. Country of citizenship
Foreign Address: Please type exactly as it should appear in English on an envelope.
Email (preferred method of communication)
Telephone number (include country code)
Date of Birth (MM//DD//YYY)
Country of Birth
City of Birth
Country of Citizenship
Are you currently enrolled in a college or university?
Do you currently hold any immigration status in the United States? (BI, FI, JI, Other)
If yes, please indicate your visa type:
F1 Nonimmigrant student
F2 F-1 Dependent
M1 Nonimmigrant voc student
M2 M-1 dependent
J1 Exchange Visitor
J2 J-1 dependent
B1 Temp visitor for business
B2 Temp visitor for pleasure
C1 Alien in-transit thru US
H1B Specialty Occupations
H2B Temporary Worker
H4 H nonimmigrant dependent
R1 Religious Workers
R2 Spouse or child of R1
TN Trade visas Can./Mex.
Is English your native language (language spoken in your home)?
If English is not your native language, what is your native language?
What was the language of instruction in your high school?
Enter all high schools attended.
Enter all higher education institutions attended. (Name of school, education level, and list country)
CCC requires English proficiency for admission. You will need to provide ACT, SAT, TOEFL (School code is 6584), IELTS or Duolingo. Choose the assessment you have completed. Send official scores to Central Community College. *Applicants from Australia, Canada (except Quebec), Common Wealth Caribbean, Ireland, New Zealand or United Kingdom are not required to provide English proficiency.
None of the above
Enter your English proficiency assessment scores below:
Emergency Contact: List a family member's first and last name
Emergency Contact: email address
Emergency Contact: Telephone number
What degree do you intend to enroll in at Central Community College?
-- Select an option --
Associate of Arts
Associate of Science
Advanced Manufacturing Design Technology
Auto Body Technology
Business Administration (Accounting)
Drafting and Design Technology
Early Childhood Education
Environmental Health and Safety
Health Information Management Services
Heating, Air Conditioning, and Refrigeration
Heavy Equipment Operator Technician
Hospitality Management and Culinary Arts
Library and Information Services
Medical Laboratory Technician
Occupational Therapy Assistant
Expected Entrance Semester
Fall (August - must have all application materials submitted by July 1)
Spring (January - only transfer students can start in the spring and must have all application materials submitted by December 1)
Following submission of my application, I will email firstname.lastname@example.org a copy of my bank statement or sponsors bank statement with available balance of at least $19,180 US Dollars.
Following submission of my application, I will email email@example.com a copy of my financial affidavit.