West Valley College

International Student Admissions

14000 Fruitvale Avenue
Saratoga, CA 95070-5698 USA

Office Use Only

ID# Res Code Reg Date Initial Date

International Student: Application for Admission

This application is for: West Valley College Mission College
Term Year: Fall Spring

Applicant Information
Legal Name as it appears on your Passport:

Last Name First Name Middle Name

Other/Previous Names used at this College:

Last Name First Name Middle Name

Mailing Address:

Number or PO Box Street Apt. No.

City State Zip Code Country

Home Country Address:

Number or PO Box Street Apt. No.

City State Zip Code Country

Phone Numbers:

Home Number Business Number Cell/Pager Number

Email Address: Gender: Male Female

Birth Information:

Birth Date (Month/Day/Year) Age Place of Birth (State or Country)

 West Valley College
International Student Admissions
14000 Fruitvale Avenue
Saratoga, CA 95070-5698 USA

Predominant Ethnic Background:

Asian (A) African-Amer./Non-White (B) Pacific Islander (P)
Chinese (AC) Filipino (F) Guamanian (PG)
Asian Indian (AI) Hispanic (H) Hawaiian (PH)
Japanese (AJ) Mexican American (HM) Samoan (PS)
Korean (AK) Central American (HR) Other Pacific Islander (PX)
Laotian (AL) South American (HS) White (W)
Cambodian (AM) Other Hispanic (HX) Unknown (X)
Vietnamese (AV) American Indian (N) Decline to State (XD)
Other Asian (AX) Other Non-White (O)

Educational Background and Goals

Program of study you intend to pursue at this college:
AA/AS Transfer Certificate Undecided
Major:
Admit Status:
First time college student Previously attended another college
Returning to West Valley-Mission CCD Returning transfer to West Valley Mission CCD
Continuing Concurrent enrollment (Grade K-12)
Educational Goals:
Transfer to a 4-year college with associate degree (A) Associate degree, occupational major (D)
Transfer to a 4-year college without associate degree (B) Associate degree without transfer (C)
Occupational certificate program (E) Formulate career interest (F)
Prepare for a new career (G) Update job skills (H)
Licensing requirements (I) Improve basic skills (K)
Personal interest/educational development (J) Obtain High School diploma/GED (L)
Undecided (M)
Immigration Information
Indicate your immigration status by checking the appropriate box and entering the date issued.
Permanent Resident Alien # Date Issued:
Temporary Resident Date Issued:
Refugee/Asylee/ Amnesty recipient/Parolee Date Issued:
Student visa (F-1 or M-1) Date Issued:
Other (Specify) Date Issued:
Status Unknown
Of which country are you a citizen?
 West Valley College
International Student Admissions
14000 Fruitvale Avenue
Saratoga, CA 95070-5698 USA

Is English your primary spoken language: Yes No

If no, what is your primary language?
Are you a: Foreign Country Resident Out of State Resident
General Information
Special Services - check all that may be of interest:
Adult Re-Entry (AR) Basic Skills (BS) Campus Clubs & Org. (CO)
Career Planning (CP) Child Care (CC) Counseling Services (CS)
Disabled Student Svcs (DS) Employment Assist. (EA) English as a 2nd Lang. (ES)
Health Services (HS) Honors Program (HP) Job Placement (EA)
Testing/Assessment (TA) Transfer Services (TR) Tutorial Services (TI)
Prior Education
Student Type - select the highest level of education you have completed:
Foreign Bachelor’s Degree or higher Foreign Associates Degree
Foreign High School Graduate Foreign High School Proficiency Certificate
Received Foreign GED or CA Equivalency Received Foreign High School Diploma
Currently Enrolled in Foreign Adult School Not Graduated/Not High School Enrolled
Graduated from high school? Yes If Yes, date graduated (Month/Year)
No If No, anticipated graduation (Month/Year)
Year of last attendance: High School GPA:
College you attended most recently (other than this college)

College State Year of last attendance

Highest college degree received Date College (if different from above)

What is the primary reason you decided to enroll at this college?

Declaration
I declare under penalty of perjury that the statements and information submitted on this Admissions Application
are true and correct. I understand that all materials submitted by me for purposes of admission become the
property of the West Valley-Mission Community College District. I also Understand that falsification,
withholding pertinent data or failure to report changes in residency or educational status may result in District
action. Finally, in registering for future terms, I agree to provide true and correct information about any change
in my educational status.

Student Signature Date

Please return to: International Student Office, West Valley College, 14000 Fruitvale Avenue, Saratoga, CA
95070-5698 USA