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INTERNATIONAL STUDENT APPLICATION

1)Student Information

Last Name _________________________ First Name _________________________ Middle_________________

Home Country Address U.S. Address

Street: Street:

Apt/Unit: City:
City: State/Province: State: Zip Code:
Country: Postal Code: Home Phone:
Telephone: Cell phone:
E-mail:

City of Birth _____________ Country of Birth _____________ Country of Citizenship _______________________

Date of Birth __________________________ Gender: Male Female

2)How did you learn about ASA College? _______________________________________________________________

3)Program of Study
Program Name ____________________________ Start Date __________________ Number of Weeks __________
for IEP
Campus Location: Manhattan Brooklyn Hialeah

4)Visa Information
Please indicate the purpose of your I-20 Certificate:
Initial Change of Status Transfer
If currently in the U.S., what is your visa status? B-1/B-2 F-1 J-1 Other ___________
Do you want us to help you find accommodations? Yes No

5)Dependents Information. If you have dependent (spouse, child), please fill out the information below.
Last name: _____________________________ First name: _________________________ MI: ____________

Date of birth: _______________ Country of birth: _________________ Country of Citizenship ___________________

Gender: Female Male Relationship to the student: Spouse Child

6)Education History
Highest level of education completed: High School Associate’s Bachelor’s Master’s or higher

7)Emergency Contact. Please provide emergency contact information:

Name____________________________________________________ Telephone _________________________

E-mail Address ____________________________________________ Relationship ________________________

8)Applicant Statement
I certify that the information provided herein is true, correct and complete to the best of my knowledge, and that all required
documentation has to be submitted along with this form. I agree to comply with all rules and regulations as set forth in the ASA Student
Handbook.

Signature of Applicant ________________________________________________ Date _______________

Non scholae, sed vitae discimus!