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New International Student Supplemental Application Form

This application form is for new International students seeking Admission to Clinton Community College.


Family Name: *


Middle Name:


First Name *


Gender: *
 Male
 Female


Date of Birth: (MM DD YYYY) *


Country of Birth: *


Foreign Address: Must be outside of United States. Type exactly as it should appear in English on an envelope. *


Country Code: *


City Code: *


Number: *


Email address (preferred method of communication): *


Do you currently hold any immigration status in the United States? *
 Yes
 No


If yes, please indicate your visa type:


Have you ever been convicted of a felony (a crime for which more than one year of prison may have been imposed)? *
 Yes
 No


Have you ever been dismissed from a college or university for disciplinary reasons? *
 Yes
 No


Is this your first time enrolling in a college or university? *
 Yes
 No


Have you been enrolled or are you currently enrolled in a college or university? *
 Yes
 No


Is English your native language (the language spoken in your home)? *
 Yes
 No


If no, what is your native language?


What is the language of instruction in your high school? *


Country of Citizenship *


Have you taken an English proficiency exam, such as the TOEFL or IELTS? (These exams are not required for Admission) *
 Yes
 No


Father's family (last) name: *


Father's first (given) name: *


Mother's family (last) name: *


Mother's first (given) name: *


Parent or Guardian's email address: *


Is anyone helping you with the application process? *
 Yes
 No


If yes, please indicate the advisor's name and title (for example: Mr. Smith, School Counselor):


Advisor's Phone Number Country Code:


City Code:


Number:


Advisor's email address:



Educational Data:


Please list all secondary schools and universities attended: *


Secondary Schools (High School): Grade Level *


Secondary Schools (High School): Years Attended *


Secondary Schools (High School): Name of School *


Secondary Schools (High School): Location: City & Country *


Secondary Schools (High School): Diploma Type *


College or University: Grade Level


College or University: Years Attended


College or University: Name of School


College or University: Location: City & Country


College or University: Diploma Type


Can you provide documentation of your immunization health records? *
 Yes
 No


Semester of Study *


Domestic Mailing Address: (Optional)


Program of Study:



Please submit the completed application form. A member of our staff will be contacting you soon to discuss your application status and to discuss additional steps.