International Student Supplementary Information

I plan to attend CCC (Campus Location)

Grand Island, Nebraska Columbus, Nebraska Hastings, Nebraska Kearney, Nebraska

First Name/Primary Name

Middle 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)

Gender

Female Male

Country of Birth

City of Birth

Country of Citizenship

Are you currently enrolled in a college or university?

Yes No

Do you currently hold any immigration status in the United States? (BI, FI, JI, Other)

Yes No

If yes, please indicate your visa type: Select one 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 H1C Nurses H2B Temporary Worker H4 H nonimmigrant dependent K1 Fiance R1 Religious Workers R2 Spouse or child of R1 TN Trade visas Can./Mex.

Is English your native language (language spoken in your home)?

Yes No

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. Select one ACT SAT TOEFL IELTS Duolingo 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 Agricultural Science Auto Body Technology Automotive Technology Business Administration Business Administration (Accounting) Construction Technology Criminal Justice Dental Assisting Dental Hygiene Diesel Technology Drafting and Design Technology Early Childhood Education Electrical Technology Energy Technology Environmental Health and Safety Health Information Management Services Heating, Air Conditioning, and Refrigeration Heavy Equipment Operator Technician Hospitality Management and Culinary Arts Human Services Information Technology Library and Information Services Mechatronics Media Arts Medical Laboratory Technician Nursing Occupational Therapy Assistant Paramedicine Pharmacy Technician Quality Technology Truck Driving Welding Technology

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)

Upload a copy of your valid passport.

Upload a copy of your translated secondary school transcripts.

If applicable, upload a copy of your translated college or university transcript.

Following submission of my application, I will email [email protected] a copy of my bank statement or sponsors bank statement with available balance of at least $19,180 US Dollars.

Yes No

Following submission of my application, I will email [email protected] a copy of my financial affidavit.

Yes no

Passport Information

Passport Number

Passport Expiration Date

Passport Country of Issuance

Current Residency & Student Visa Status:

Are you currently residing in the US?

Yes No

What is your visa student status?

Applying for a new F-1 visa from my home country Transferring my current valid F-1 visa to CCC (if so complete transfer form) Charging my current valid status from (current visa status) to F1 Other

If you are currently studying in the US, what is the name of the college or university that you are attending? (Transfer students must complete a Central Community College transfer-in form and contact their international Student Advisor at their current university to release their SEVIS record to Central Community College. Central Community College will issue the Form I-20 after receiving a transfer-in form and all other required documentation.) F-1 student must arrange for a transfer of their SEVIS record within 60 days following successful completion of a program of study at another university or within 60 days following an authorized period of OPT.

Have you ever been suspended or dismissed from any college or university?

Yes No

If YES, please list the name of the school

I certify that the information on this application is complete, accurate, and true: and agree to abide by the policies and regulations of Central Community College. I understand that any information given falsely or withheld will affect the decision on my application and may make me ineligible for admission and or enrollment.

Submit