International Student Fact Sheet
This form must be completely filled out to insure that you receive the proper forms to obtain your visa.
________________________________________________________________________________
Family/Last name
First name
Middle name
Name you use
___________________________________________________________________________________________________
Number/Street/Apartment
___________________________________________________________________________________________________
City/State/Postal(Zip) code/Country
___________________________________________________________________________________________________
Phone number
Fax number
E-mail
___________________________________________________________________________________________________
Emergency contact Name
Emergency contact phone
___________________________________________________________________________________________________
Month/day/year
City and Country of Birth
Country of Citizenship _________________________
Country of permanent residence ________________________
Anticipated Duration of Stay in the United States: Semester _____ Academic Year _____ Degree program ____________
Anticipated Date of Arrival: _____________________________ (month/year)
Do you already have a passport? Yes____
No____
Passport # _____________________ Country of Issuance ______________ Date issued ________ Expiration date _____
Mm/dd/yyyy
Do you already have a US visa? Yes_____
mm/dd/yyyy
No ____
If yes, what type? F ___ J ___ B ___ H ___ L ___ Other ________________________________
If yes, what is your visa number? _____________________________________________________
From which Embassy or Consulate did you receive your visa (City/Country) _______________________________________
If you are presently in the U.S., provide your Admission Number which appears on your I-94 arrival/departure document.
Does your government/sponsor require you to have a certain type of visa? Yes ____
If yes, which type?
No ____
F _______ J ______ Other __________
Are you: single ______ married _____ divorces _____ widowed ______ Number of Children _______
Do you plan to bring your family with you? Yes _____
No _____
Spouse’s name
Birthdate (mm/dd/yy)
Profession
Country of Birth
Name
Birthdate (mm/dd/yy)
Relationship to student
Country of Birth
Name
Birthdate (mm/dd/yy)
Relationship to student
Country of Birth
Name
Birthdate (mm/dd/yy)
Relationship to student
Country of Birth
Name
Birthdate (mm/dd/yy)
Relationship to student
Country of Birth
Name
Birthdate (mm/dd/yy)
Relationship to student
Country of Birth
International/Intl Student Fact Sheet
9/28/2005
1
All international students, except those whose official native language is English, are required to submit the results of the Test of
English as a Foreign Language (TOEFL/TWE) IELPT, IELTS or any other acceptable English test. The Results must be sent
directly to the International Office. If you do not meet minimum scores, you may be required to take additional English courses prior
to enrolling in full-time academic work. Upon arrival on campus, you will meet with the International Student Advisor for final English
placement.
Have you taken the TOEFL? Yes ______
No ______
Date _____________
Have you taken the TWE?
No ______
Date _____________
SCORE
Sec. 1
Yes ______
Sec. 2
Have you taken any other test of English proficiency
You must provide an official copy of the test score.
Sec. 3
Sec. 4
Yes ______
No ______
Name of Test ___________________________________Score _____________________ Date of Test __________________
Have you ever studied English formally? Yes ______
No ______
With which organization, school or institution did you study? _____________________________________________________
What was the length of study? _____________________________What level did you complete ________________________
Have you ever visited or lived in an English-speaking country? Yes ______
No ______
Which country_______________________________
When _______________________________________
Length of stay _______________________________
Purpose of visit _______________________________
List all of the languages you speak? _______________________________________________________________________
What kind of financial support will you have to attend CSM? You must complete the STATEMENT OF SUPPORT, and attach a
letter from your sponsor giving the exact amount in U.S. dollars ($) you will receive. These forms must be attached before
visa documentation can be issued.
____
Government
Name of Sponsor _____________________________________________________
____
Private Company
Name of contact Person________________________________________________
____
Family
Address/Country _____________________________________________________
____
Personal
Phone number _______________________________________________________
____
Other
E-mail ______________________________________________________________
As you complete this application form, check off each item as it is ready to mail to the Admissions Office. This application will NOT
be considered if it is not complete.
____
____
____
____
____
____
Results of TOEFL/TWE mailed directly from the Educational Testing Service
Official transcripts (grade reports), certificates, and/or diploma demonstrating completion of preparatory studies for higher
education.
Certified literal translations of all transcripts and supporting documents that are in languages other than English.
List of courses in which you are currently enrolled (if applicable)
Confidential statement of support (approximately $1,800.00-$2,000 per month incl. tuition, housing, meals, etc.)
Supporting documents or letters from bank of sponsoring agency.
International/Intl Student Fact Sheet
3/3/2016
2