International Student Application

Before completing this application, please read the Admission Procedures for International Students page carefully. Be sure to answer all questions on the application.

Instructions: You may (1) print the application form, then fill it out by hand; or (2) fill out the form online, then print it. Either way, you must sign your name in the Certification section at the end of the page. Directions for submitting this application by mail are near the bottom of the page.

Student I.D. and Desired Admission Date

Student I.D. or Social Security Number: (leave blank if none available)

Semester/year for which you are seeking admission: Please select one Fall 2005 Spring 2006 Summer 2006 Fall 2006 Spring 2007 Summer 2007 Fall 2007 Spring 2008 Summer 2008 Fall 2008 Spring 2009 Summer 2009 or write in: ________________

General Student Information

Provide your full legal name below:
Last:	First:	Middle:
Date of Birth (mm/dd/yyyy): Age:		Sex: Male Female
Country of Birth:
Citizen of: Primary Language:

Contact Information

Home Address and Phone Number

Home Street Address:

City: State:

Country: Postal Code:

Home Phone — Area Code: ( ) Phone: Extension:

Local Address and Phone Number

Local Street Address:

City: State: Zip Code:

Local Phone — Area Code: ( ) Phone: Extension:

Correspondence

E-mail Address:

Where should the I-20 and acceptance materials be sent? Home Address Local Address

Visa Information

If you are in the U.S., please mark the type of Visa you currently have:

Tourist (B-1/B-2) Student (F-1) Other—Identify "other" type of visa:

No visa (applying from outside of U.S.)—Please skip to next section (Education).

For Students Currently Inside the U.S. Will you be traveling outside the U.S. before beginning your studies at CCC? Yes No Are you a transfer student from another U.S. college? Yes No If yes, please list name of college:

Education

Proposed field of study at Coastline Community College:

Have you previously applied to Coastline Community College? Yes No

If yes, which semester and year?

Highest level of education completed: Date of Graduation (mm/dd/yyyy):

List any high school, college, university, or language program that you are currently attending, or have attended in the past: School, College, University Country Dates Attended Degree Earned

IMPORTANT: Arrange for the most recent institution listed to send an official transcript translated into English to the International Student Office at Coastline Community College. No action can be taken on an application until the necessary transcript has been received.

Application Fee

There is a $30.00 (U.S. currency) non-refundable processing fee for the application.

Personal Check (Make check payable to Coastline Community College.)

Money Order

Traveler's Checks

Credit Card Choose one: Visa MasterCard Discover Credit Card Number: Expiration Date (mm/dd/yy): Amount: $30.00 Date of Signature: ___________________________________ Authorized Cardholder's Signature: ____________________________________________________

Cash (Cash payments are only accepted in person—please do not send cash.)

Certification

I certify that I have carefully considered each question above and that my statements are true and complete to the best of my knowledge.

Applicant's Signature: ___________________________________________ Date: ___________________

Instructions for Submitting Application and Supporting Documents

Please mail your complete application and supporting documents to:

Coastline Community College, Le-Jao Center
Attn: Linda Maynard, International Student Advisor
14120 All American Way
Westminster, CA 92683

Return to the International Students home page.