Application Checklist

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1 Application Checklist Mail the following documents to apply as an international student. Application for Enrollment (fillable document on pages 5 and 6) Personal Data Statement (fillable document on page 9) Proof of English Proficiency (if necessary -- see page 3) Declaration of Financial Recourses/Affidavit of Support (fillable document on page 10) Notarized bank letter (obtain official documentation from your bank -- see page 14) Education documentation (obtain official documentation from your school -- see page 4) Copy of I-20 (if currently attending school in U.S.) Copy of passport After you are accepted, you will need to bring these items to register for classes. Signed I-20 (included in your acceptance packet) F-1 Visa (see page 14) I-94 card Completed Immunization Form for College Students (see page 12) Mail all documents to Rob Giovino PDSO-International Student Admissions Community College of Rhode Island 400 East Avenue Warwick, RI

2 Immunization Form for College Students In accordance with the Rhode Island Department of Health s Rules and Regulations Pertaining to Immunizations and Testing for Communicable Diseases for Students Entering Colleges or Universities (R23-1-IMM/COL), the following student populations must complete and return this form. All incoming full-time students in any program of study must complete section A and have section B completed and signed by a licensed health care provider with the exception of high school records or VA records. Students in a health care field of study should refer to immunization forms provided by their department. TE: Titers are available through East Side Lab for a discounted rate. You must contact CCRI s Health Services nurse for a lab slip at Part A: Personal and Student Information Date: CCRI ID*: Student s name: Last, First, MI Date of birth: Phone number: address: Program of study: Part time Full time Campus: * A Social Security number also can be used but a CCRI ID is preferred. Don t know your CCRI ID number? You can find it printed on a bill or a class schedule, in your MyCCRI account or by contacting Enrollment Services. Part B: Immunization Information All information is REQUIRED. Do not overlook the chicken pox requirement. Please note that students carrying less than 12 credits do not need to submit this form. Any student who cannot access childhood records can have titers done at a discounted rate. Please contact the CCRI nurse for more information. MMR 1 st dose 2 nd dose Hepatitis B 1 st dose 2 nd dose Varicella 1 (Chicken Pox) dose 2 nd dose Tdap Date: 3 rd dose Was titer done? Acceptable in place of vaccine dates if unable to obtain immunization records. Attach lab work Attach lab work Attach lab work Meningitis 1 st dose Strongly recommended 2 nd dose Strongly recommended under age 22, but not if 1 st dose given prior required. to age 16. Health Care Provider signature Date Please return all forms to: Phone CCRI Health Services, Room 1240 Please note that if you have graduated from a Rhode Island high school within the past five years, you should be able to obtain a copy of your immunizations from that high school. Angela Marshall, RN 400 East Ave. Warwick, RI Fax (401)

3 International Student CCRI ID Number: For Office Use APPLICATION FOR ENROLLMENT Tell us about your interest in CCRI. Please share this information with us so that we can better advise you on your best course of action at CCRI. First time in college. I have never attended any college before. Transfer. I am entering CCRI and I have previous college-level coursework. 1 Complete this form after you have read the application instructions and after you have reviewed our program listings. Please print clearly. Date of Application Name as it appears on passport Last Name First Name Middle Initial Date of Birth Mo / Day / Yr Previous/Maiden Name Last Name First Name Middle Initial Mailing Address Gender: Male Female City State Country ZIP Home Telephone Number Cell Number Address: How long have you lived at current address? Number of years at previous address / If less than nine months, please list previous address: Years months Street City State ZIP Country 2 The information that you provide helps us to comply with federal statistical reporting requirements only and will not, in any way, affect an admissions decision on your application. Federal regulations require colleges to report enrollment data by racial, ethnic and gender categories. Ethnicity: (Not used for admission. Please check one.) Not Hispanic or Latino Hispanic or Latino Federal regulations require colleges to report enrollment data by racial, ethnic and gender categories Race: (Not used for admission. You may check more than one race.) American Indian or Native American Asian Black of African American Native Hawaiian of Pacific Islander White Choose not to report Important Information: (Check all that apply.) One or both parents (biological or adoptive) earned a four-year degree Single parent with custody of a child under 18 Speaker of English as a second language Displaced homemaker* Ethnicity/Race data reporting for federal purposes has changed. The selections that you see in this section are the choices as mandated by the federal government for higher education reporting purposes. Only statistical numbers are reported. No individual data appears on the Federal reports. * The term displaced homemaker refers to women or men who have worked mainly in the home for a minimum of two years caring for home and family. Due to loss of family financial support (usually through death, disability or divorce), these individuals must leave the home and seek to support themselves and their families. 3 Please note: Misrepresentation concerning residency and/or citizenship is grounds for immediate dismissal from the college and liability for all tuition and fees that may result. A. I declare my legal residence to be the following foreign country: 2 Office Use

4 International Student 4 Please indicate your program choices. Please print clearly. Why are you enrolling at the Community College of Rhode Island? Please help us to better serve each of our students by providing us with the primary reason that you are seeking to enroll at CCRI (please check only one of the following): I wish to obtain an associate degree from CCRI. I wish to obtain an associate degree from CCRI and then transfer to a four-year school. Please Note CCRI has a performance-based application process for Health Science programs. Those who apply to these programs are accepted into General Studies. Once preadmission requirements for the desired Health Science program are completed successfully, the students must submit a performance-based Health Science application. Acceptance is based on a point system where points are earned by academic achievement. Submission of a performance-based Health Science application does not guarantee acceptance into the program. What program of study are you interested in pursuing? I am interested in a degree program 1st choice Campus 2nd choice Campus Program of study name Program of study name Intended Entry Date x Fall YEAR 5 High school history: Please complete as appropriate. Please print clearly. I have or will have: High school diploma GED credential Code DIPLOMA DATE MONTH/DAY/YEAR DATE RECEIVED Code MONTH/DAY/YEAR Please forward a copy of your translated and evaluated official high school transcript or GED credential to the Office of Enrollment Services as soon as it is available. 6 College history. Please list ALL colleges and universities previously attended and submit official transcripts with translations and evaluations. Please print clearly. COLLEGE 1: College/University name Code City State Degree COLLEGE 2: College/University name Code City State Degree COLLEGE 3: College/University name Code City State Degree If prior college experience, please indicate highest degree earned: 7 Agreement: I certify that the information that I have provided on this application is true and correct. Further, by signing this form, I agree to abide by the rules and regulations at, and fulfill all financial obligations to, the Community College of Rhode Island. Applicant's signature Application date 3

5 Personal Data Statement HOME COUNTRY ADDRESS Name Mr. Mrs. Miss Ms. Last First Middle (check one) Address City Province/Territory Postal Code Country U.S. ADDRESS Address City State Zip Address_ Phone Country of Citizenship Country of Birth Date of Birth Native Language Passport Number Expiration Date Marital Status: Married Unmarried Children If you are married or have children, will your spouse or children come with you? Yes No Contact Person in the U.S._ Phone Where do you want us to send your I-20: Home Country U.S. Address Pick up FOR APPLICANTS CURRENTLY IN THE UNITED STATES What type of VISA do you have? (F-1 or other, please specify) Expiration Date of Current VISA I-94 Card Date on Entrance 4 I-94 Card Date of Expiration

6 Declaration of Financial Resources/ Affidavit of Support To be completed by Financial Sponsor I,, will financially sponsor in his/her academic studies at the Community College of Rhode Island. I am fully aware that my sponsorship will financially cover a full course of study (12 or more credits) each semester the student is attending CCRI under the F-1 Visa holder SEVIS I-20. I,, will be directly responsible for all payments made to CCRI Bursar Office. I,, understand that any non-payment or late payments of student tuition and/or fees resulting in a Bursar Office student account hold, under full course of study or any other action affecting student enrollment is a direct violation of the students F-1 Visa status and SEVIS I-20. I will be directly responsible for academic year at the Community College of Rhode Island: Full-time tuition and fees = 12,200* Books and supplies = 1,200* Transportation = 2,600* Other education expenses = 2,100* Average room and board (includes utilities) - not available at CCRI = 9,600* *Amounts are subject to change Total rounded expenses to be reflected in financial form and notarized letter on bank letterhead = $27,700 Name of family member or sponsor Relationship to the student Address Phone Signature Date This Affidavit of Support MUST be notarized and accompanied by a notarized letter from your bank (in English or translated) showing a minimum cash savings balance equivalent to at least $27,700 U.S. dollars. Notary Stamp/Seal Notary Signature Date _ 5

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