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KALAMAZOO VALLEY COMMUNITY COLLEGE
INTERNATIONAL STUDENT
Concurrent Enrollment Agreement
(F-1 Immigration Classification)
_________________________________________________________________________
NAME OF APPLICANT (as it appears on official
documents)
IMMIGRATION STATUS________________
_____________________________________________ _________________________________________
Family name/Surname/Last name
First name
STUDENT NUMBER __________________________ DATE OF
BIRTH______________________
COUNTRY OF BIRTH ____________________________
COUNTRY OF CITIZENSHIP ___________________
INS ADMISSION No. ___________________________
CURRICULUM ____________________________
(from I-94, if known)
SCHOOL CURRENTLY ATTENDING
_______________________ CREDIT HOURS CURRENTLY ENROLLED IN _________
SEMESTER AND YEAR YOU WISH TO ENROLL AT KVCC:
I understand that my admission to Kalamazoo
Valley Community College is for concurrent enrollment only and that I must
obtain approval to attend each semester. I also understand that if I wish to
transfer to KVCC, I must complete an application for admission, have a transfer
recommendation completed and have a new I-20 issued from KVCC.
I authorize the DSO at the school issuing my I-20
to release any record-keeping information needed to KVCC. I also authorize KVCC
to release any record-keeping information needed to the DSO at the school
issuing my I-20.
I have read, understand and agree to the above.
___________________________________________________________
___________________
Signature of Applicant
Date
_________________________________________________________________________
INSTITUTIONAL CERTIFICATION FOR
CONCURRENT ENROLLED INTERNATIONAL STUDENT
___________________________________________________
Print Name of Designated School Official
____________________________________________________________
__________________
Signature
of Designated School Official
Date
____________________________________________________________
__________________
School
Name
Telephone Number
Revised July 1998
Admissions, Registration and
Records Office
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