Application - International Programs - Green River Community College

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International Student Application

* Required Information

Personal Information

Enter your name as it appears in your passport

Last Name * (Family name or surname)

First Name * (Given name)

Middle name(s), if any:

Date of Birth * (Example: 01/31/1997)

/ /

Note: Applicant must be 16 years of age by program start date.

Gender * MaleFemale

Student Status * New StudentTransfer StudentReturning GRCC Student

Immigration Information

Country of Birth *

Country of Citizenship *

Native Language

English Ability FluentAveragePoor

Visa Type F-1 StudentM-1 StudentJ-1Other

Dependents arriving with you SpouseChildren

Contact Information

Please enter your permanent home country address:

I live here now

Street Address *

City *

State/Province *

Zip/Postal Code *

Home Country *

Your Phone

Your Email *

If your parents have different information, please enter it here:

Parents Street Address

City

State/Province

Zip/Postal Code

Parents Country

Parents Phone

Parents Fax

Parents Email

Agency/Advising Center/Other Information (if applicable):

Agency Name

Agency Contact Person

Agency Address

City

State/Province

Zip/Postal Code

Agency Country

Agency Phone

Agency Fax

Agency Email

Where would you like your I-20 sent? * Current AddressParents AddressAgency/Advising Center/Other

If you have a relative in the U.S. please enter their contact information

Relative Name

Relative Address

Relative Phone

Relative Fax

Relative Email

Who should be contacted in case of an emergency or medical situation?

Emergency Contact Name

Relationship

Emergency Contact Phone

Emergency Contact Cell Phone

Emergency Contact Email

Emergency Contact Country

English Speaking? YesNo

Medical Information

Do you have any medical conditions or allergies? YesNo

If yes, please describe

Do you require any special physical or learning accommodations? YesNo

If yes, please describe

Health insurance is required for all international students.

If you bring your own health insurance, it must meet minimum requirements.

Choose your health insurance coverage I will purchase health insurance through GRCC
I will bring my own health insurance

Education

Name of high school you are attending/have attended

Are you a high school graduate? YesNo

If yes, month and year of graduation (Example: 01/2013)

TOEFL Score

TOEFL Test Date (Example: 01/31/2013)

IELTS Score

IELTS Test Date (Example: 01/31/2013)

When would you like to start at GRCC? * Spring/April 2013Summer/June 2013
Fall/Sept. 2013Winter/Jan 2014
Spring/April 2014Summer/June 2014

If other, please specify

What would you like to study? Check all programs that relate to your studies at GRCC. You may check more than one box.

University Transfer
Intensive English (IESL)
High School Plus
Associate Degree
Certificate
Gap Year

Other Program

What will be your major? *

How long will you attend GRCC? *

University Transfer Pathway

A letter of admission to a 4-year university may requested at the same time you apply for Green River. Please find a complete description of the UTP program and the most recent list of UTP universities.

Yes-I request a UTP letter of admission

Financial Information

How will you pay your tuition and living expenses? *

Personal Funds
Family Funds
Government sponsorship from home country
Company sponsorship from home country
Sponsor with the U.S. (I-134 Required)
Other

If other, please specify

Which payment option will you use to pay for application and placement fees? Credit CardCheck/Draft
Bank Wire TransferMoney Order

Housing Selection

Housing placements are made in the order completed applications and placement fees are received. Preferences are met based on availability.

If you have your own housing, please check the box below

I have or will find my own housing

Please provide the U.S. address if known

Release of Information & Admission Policy

Please choose to authorize or decline the release of information * I authorize GRCC to release academic records and immigration status information to my sponsor, educational agency and/or parents.
I decline to authorize release of any information.

Admission Policy

New students who use GRCC's I-20 to enter the U.S.A. must:

Report in person to GRCC's orientation session for new international students
Enroll for and attend the first quarter at GRCC
Present originals of: passport, visa, I-94 and GRCC I-20**
Carry Health Insurance while enrolled at GRCC

** Students transferring from other U.S. schools must present their most recent I-20 instead of a GRCC I-20.

By checking the box below I verify that, to the best of my knowledge, all of the statements on this form are true. I have read and agree to the published International Student Admission Policies. All statements are true and I agree to the policies. *

Information for:

International Student Application

International Student Application

Enter your name as it appears in your passport

Please enter your permanent home country address:

If your parents have different information, please enter it here:

Agency/Advising Center/Other Information (if applicable):

If you have a relative in the U.S. please enter their contact information

Who should be contacted in case of an emergency or medical situation?

Health insurance is required for all international students.

University Transfer Pathway

If you have your own housing, please check the box below

Green River has two housing choices for new applicants. What is your preference?

Campus Corner Apartment Applicants Complete This Section

Homestay Applicants Complete This Section

Admission Policy