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KALAMAZOO VALLEY COMMUNITY COLLEGE
INTERNATIONAL STUDENT
QUESTIONNAIRE
_____________________________________________________________________________
IMMIGRATION STATUS ________________ NATIVE LANGUAGE_________________________
NAME OF APPLICANT (as it appears on official documents)
________________________________________________
_________________________________________
Family name/Surname/Last
name
First name
COUNTRY OF BIRTH ____________________________ DATE OF BIRTH
________________________
COUNTRY OF CITIZENSHIP ________________________ INS ADMISSION NO.
_________________________
(from I-94, if known)
PROGRAM OF STUDY _____________________________________________
PERMANENT HOME ADDRESS
__________________________________________________________________________________
Number
Street
____________________________
_____________________
_____________ _______________
City
State/Province
Zip/Postal
Code
Country
__________________________
_______________________
______________________________
Phone
Number
Fax
Number
E-Mail Address
U.S. ADDRESS
__________________________________________________________________________________
Number
Street
____________________________
_____________________
_____________ _______________
City
State/Province
Zip/Postal
Code
Country
__________________________
_______________________
______________________________
Phone
Number
Fax
Number
E-Mail Address
_____________________________________________________________________________
_________
Answer the following
questions only if you are an F-1 student transferring from another U.S. academic
institution. You must also have the institution from which you are transferring
complete a Notice of Intent to Transfer form.
LAST U.S. ACADEMIC INSTITUTION
ATTENDED_______________________________________________________
STUDENT IDENTIFICATION NUMBER _________________________________
HAVE YOU EVER APPLIED FOR REINSTATEMENT ______ Yes ______ No
IF YES, WAS IT APPROVED?______ Yes ______ No ______ Pending
IF YES, FOR HOW LONG? _____________________ o
Full Time o
Part Time
HAVE YOU BEEN AUTHORIZED FOR CURRICULAR TRAINING? ______ Yes ______ No
IF YES, FOR HOW LONG? _____________________ o
Full Time o
Part Time
Revised July 1998
Admissions, Registration and Records Office
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