International Student Application - Green River Community College International Programs

International Student Application Page 1 of 3

Personal and Contact Information
* Required Information * Student Status: New StudentTransfer StudentReturning GRCC Student
* Date of Birth (Month/Day/Year): / / Example Format: 05/27/2008
* MaleFemale MarriedSingle
* Last Name (family, as it appears on passport):
* First Name (given, as it appears on passport):
* Middle name(s), If any:
* Country of Birth:
* Country of Citizenship:
Native Language: English Ability: FluentAveragePoor
What type of visa will you have while studying at GRCC? F-1 StudentM-1 StudentJ-1Other
Any dependents arriving with you? Spouse Children
Parent's street address(in your home country):	Current street address(if different from parents):

City:	City:
State/Province:	State/Province:
Country:	Country:

Zip/Postal Code:	Zip/Postal Code:
Phone: Fax:	Phone: Fax:
Email:	Email:
* Where would you like your I-20 sent? Parent's AddressCurrent AddressAgency/Advising CenterOther
Agency/Advising Center or other mailing address (if applicable)
Agency Name:	Agency Contact Person:
Agency Address:
Agency City:	Agency State/Province:
Agency Country:
Zip/Postal Code:
Phone: Fax: Email:
Do you have any relatives living in the U.S.? NoYes
Name: Address: Phone: Fax: Email:
Do you have any medical conditions or allergies? NoYes Yes, describe:
Do you require any special physical or learning accomodations? NoYes Yes, describe:
Health insurance is required for all international students. If you bring your own health insurance, it must meet minimum requirements. I will purchase health insurance through GRCC.I will bring my own health insurance

Information for:

International Student Application Page 1 of 3