College/University Application Form Applicant Information: Please select Name as it appears on passport Home Address Telephone (include country & area codes) Student Email Date of Birth Country of Birth Program of Study: Check which quarter you wish to begin Year College Level Program Educational Background: Did you graduate from high school? Name of high school Year of graduation Financial Responsibility Agreement: Financial Responsibility Parent or Family Emergency Contact: Family member or guardian in your home country to contact in case of emergency Email Phone Signature Statement: College requires certification and declaration of adequate financial support from applicants student. The statement must be less than 6 months old, issued in English, and be on file before admission will be considered. It may be necessary for you to provide additional documentation to support your financial statement. I understand that I am required to pay all tuition and fees by the designated payment deadline date each quarter; otherwise, I will not be permitted to attend classes. I am responsible to pay an additional $50 application fee if I request an enrollment deferment. I hereby certify that the information I have provided is accurate and complete to the best of my knowledge and THAT FAILURE to disclose and submit complete and accurate information and all required documents may result in denial of admission or dismissal from the College. I do hereby also authorize to contact my relatives/friends as listed in the Emergency Contacts section in cases of an emergency. By signing below, I certify that I understand and accept the conditions listed above and agree to abide by them. Signature of Applicant Name of Applicant Signature Date