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INTERNATIONAL STUDENTS APPLICATION

Fields in bold red font are required.

US Citizens - Apply Here
This application is for international students only.


PROGRAM OF STUDY

Please select one:
I want to apply for the English as a Second Language (ESL) Program only. I am not interested in applying for academic undergraduate classes at this time.
I want to apply for academic undergraduate classes. I will take English as a Second Language (ESL) classes first, if necessary.

International students interested in a graduate/master program please click here.

CONTACT INFORMATION

Please enter your name as it appears on your passport

Last Name / Surname:

First / Given Name: Middle Name:

E-mail Address:

  Home Address

Street Address:

City: State / Province:

Country: Postal Code:

Telephone: (Home)      (Mobile)   

  Mailing Address
  (If different from home address. All documents will be mailed to this address.)

Street Address:

City: State / Province:

Country: Postal Code:

 

PERSONAL INFORMATION

Birth Date: (Format: mm/dd/yyyy)   Gender: Male    Female

Country of Citizenship:

Visa Status, if currently in US

If Visa status is not listed above, please specify:

Will anyone come with you as a dependent?
A dependent is a husband, wife or child that is already on or will need to apply for an F-2 visa. Yes   No

If yes, please list the full name of anyone that will be accompanying you as a dependent and his/her relationship to you (husband, wife or child)

Dependent Full Name: Relationship:

Dependent Full Name: Relationship:

Dependent Full Name: Relationship:

Dependent Full Name: Relationship:

For each person listed above, please send a copy of his/her passport photo page with the rest of your application documents.

 

ENROLLMENT INFORMATION

Enrollment Date:  Fall=August start date  Spring=January start date  Summer=May start date

Student Status: Freshman/First time student   Transfer

*Plan to Attend: Full-time    Part-time

* Students planning to attend on an F-1 visa MUST attend full-time.

Type of housing: Resident - Live on campus    Commuter - Live off campus*

* By choosing the commuter option, you agree to make your own living arrangements prior to your arrival on campus.

High School attended:     Graduation Month: Year:

Please list any colleges or universities that you have attended, including any that you attended for English as a Second Language (ESL) classes:

Intended Program of Study:

 

La Roche College Office of Admissions © 2014