Fillable F-1 Student Data Form (Sacramento City College)

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F-1 Student Data Form (Sacramento City College)

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Sacramento City College
International Student Center
F-1 Student Data Form
Please type your information as it is stated in your passport. An incomplete application will delay processing.
Last (Family or Surname) Name as in Passport
First (Given) Name as in Passport
Middle Name
Date of Birth (month/day/year)
Age (under 18 see page 5) City of Birth Country of Birth
Country of Citizenship
Country of Permanent Residence
Female
Male
Visa Number (if any)
SEVIS ID (if any)
I-94 Card Admission Number (if any)
Social Security Number (if any)
SCC ID Number (a seven number digits beginning with “W”)
Major Field of Study
I am applying for
FALL 20 _ _ (from August to December)
SPRING 20 _ _ (from January to May)
Permanent Overseas Address:
________________________________________________
________________________________________________
________________________________________________
District Providence/Territory
________________________________________________
City Postal Code Country
________________________________________________
Phone
Email
U.S. Address (if applicable):
____________________________________________________
____________________________________________________
Address
____________________________________________________
City State Postal Code
____________________________________________________
Phone Fax
____________________________________________________
E-mail (Overseas or U.S.)
ADDRESS CHANGES: Please inform the ISC of all changes of address within 10 days of moving. Federal Law requires you
notify USCIS by completing and mailing AR-11 Form to USCIS. USCIS Special Registration Change of Address Form (AR-
11SR) is required for students from certain countries who by law need to complete the special registration requirements. For
information, ask ISC or view USCIS website:
www.uscis.gov. Update your new U.S. address in e-Services.
Are you currently in the US?
NO
YES; verify your current visa type (e.g., F-1, F-2, J-1, J-2, other): ______________________________ Specify other visa
type. If your visa type is not F-1, verify your I-94 Card expiration date:______________________________________
Degree Objective at SCC
A.A. (Associate of Arts) or A.S. (Associate of Science)
A.A. or A.S./Transfer to 4-year-university
Degree Objective after SCC
B.A. (Bachelor of Arts) or B.S. (Bachelor of Science)
M.A.(Master of Arts) or M.S. (Master of Science)
Address
Unknown
/Other
________________________________________
Last Name First Middle
2
(Please list all high schools and colleges attended. List the most recently attended schools first.)
Name of School
City, Country
Date of Attendance
From To
(mo/yr) (mo/yr)
Language
Of
Instruction
Examination,
Certificates,
Diplomas,
Degrees
Date
Of
Graduation
1.
2.
3.
4.
Please acc
ount for any time you were not in school below:
Activity Dates (month/year to month/year)
Date of Eng
lish proficiency test taken:
NO
YES, I took the _________ test on (date) __________________________ and requested official score to be sent to SCC.
SCC ESL Assessment test
on (date)______________________________________________________________
Other: ____________________________________________________________________________________
In the pas
t, have you attended Sacramento City College?
NO
YES; semester and year attended: _______________________________________________________________________
Previous last name that may appear on your record _____________________________________________________________
How did y
ou hear about us?
Family or friend, please specify name_____________________________________________________________________
Internet, please specify the web address __________________________________________________________________
Publication or brochure, please specify the name ___________________________________________________________
Other, please specify _________________________________________________________________________________
Do you h
ave any relatives or friends who have attended Sacramento City College?
NO
YES Name(s), relationship and date of attendance: ____________________________________________________
EDUCATIONAL BACKGROUND
Revised 02/2020
________________________________________
Last Name First Middle
3
Sacramento City College does not provide financial aid for international students and on-campus student employmen
t is limited.
You are required to submit an official bank letter verifying funds in the exchange rate of U.S. dollars to confirm adequate
funding covering academic and living expenses for the first year of enrollment at Sacramento City College. (Excludes any travel
cost.)
If you have a U.S. sponsor, also submit the USCIS Affidavit of Support Form I-134 (download at www.uscis.gov) and supporting
documents.
Sources of Funds:
Myself (if you will support your own school fees) Fill out Section A only.
Parent(s) (if your parent(s) will support your school fees) Fill out Section B only.
Sponsor (money available from sources other than parents) Fill out Section C only.
Your Government (if your government will support your school fees by scholarship program) Fill out Section D only
Are you married?
NO
YES, write down your spouse’s complete name
Are you including any depend
ents (F-2) in this application? (Dependents: spouse/children)
NO
YES (Additional $3,000 for each dependent to your total bank letter.)
Please list the dependent(s) you wish to include:
Last (Family) Na
me, First Name
DOB (m/d/yr) City a
nd Country of Birth Country of Citizenship
Relationship Gender
EMERGENCY CONTACTS (MANDATORY)
SOURCES OF FINANCIAL SUPPORT
Revised 02/2020
Father’s Name________________________________________________________________________________
Address______________________________________________ City___________________________________
Providence/Territory____________________ Country ________________________ Postal Code_____________
Phone (____)_____________ E-mail ____________________________________________________________
Mother’s Name_______________________________________________________________________________
Address_______________________________________________ City__________________________________
Providence/Territory____________________ Country ________________________ Postal Code_____________
Phone (____)_____________ E-mail ____________________________________________________________
Other contact person overseas _________________________________ Relationship_______________________
Address____________________________________________ City_____________________________________
Providence/Territory____________________Country________________________Postal Code_____________
Phone (____) ______________ E-mail ___________________________________________________________
Contact person in the U.S.____________________________________ Relationship________________________
Address___________________________________________ City_______________________________________
Providence/Territory____________________ Country ___________________ Postal Code_________________
Phone (____) ______________ E-mail ____________________________________________________________
1. ____________________________________________________________________________________________________________________________________
2. ________________________________________________________________________________________
3. ________________________________________________________________________________________
________________________________________
Last Name First Middle
4
SOURCES OF FINANCIAL SUPPORT continued…
Note: Attach original bank verification.
SECTION A: MYSELF as a Principal Sponsor
I, ____________________
____________, certify that I will take full financial responsibility, including educational and living
(Name of the applicant)
expenses, for myself while I am enrolled at Sacramento City College.
Please describe the source:__________________________________________________________________________________
The total amount of $ _______________ per year is guaranteed for up to 4 years.
Name of Bank: ____________________________________________________________________________________________
SECTION B: PARENTS as a Principal Sponsor
I, ______________________________, certify that I will take full financial responsibility, including educational and living
(Name of parent(s)
expenses for ____________________________ while he/she is enrolled at Sacramento City College.
(Name of applicant)
The applicant is my _______________________. The total amount of $ _____________ per year is guaranteed for up to 4 years.
(Relationship to applicant)
Name of Bank: ___________________________________________________________________________________________
______________________
________________________________ _____________________________________________
(Sponsor’s Signature) Date
Street City Country Phone #
SECTION C: SPONSOR other than Parents
I, ______________
________________, certify that I will take full financial responsibility, including educational and living
(Name of sponsor(s)
expenses, for _______
_____________________ while he/she is enrolled at Sacramento City College (SCC).
(Name of applicant)
The applicant is my _______________________. The total amount of $ _____________ per year is guaranteed for up to 4 years.
(Relationship to applicant)
Name of Bank: ____________________________________________________________________________________________
______________________________________________________ _____________________________________________
(Sponsor’s Signature) Date
________________________________________________________________________________________________________
Street City Country Phone #
SECTION D: SCHOLARSHIP from your Government or Company
Send the original scholarship letter from your government or a company to SCC International Student Center listing dates of
coverage (NO photocopy).
Name & Address of the Agency: ______________________________________________________________________________
Contact Person: ___________________________________________________________________________________________
Phone: (____) ___________________ Fax (____) ____________________ E-mail_____________________________________
Amount of Scholarship in US$ ______________ is guaranteed from _____________ to ______________
Revised 02/2020
________________________________________
Last Name First Middle
5
Why are you pursuing a course of undergraduate study at Sacramento City College? Please discuss your education and career
goals, and explain how you plan to achieve them. What has motivated you to move in this direction? You may include additional
information concerning your preparation for the major you have specified. (Required: 150 words or more. Attach separate sheet
if necessary)
Your parent(s) or U.S. guardian must provide the official power of attorney document with the name and address of your legal
guardian in the U.S.
I certify that the information disclosed in this International (F-1)
Admission Packet to the best of my knowledge is correct. All
documents or other materials for admission become the property of the College. I understand that any misrepresentation may be a
cause for denial or dismissal of admission and if accepted, I agree to comply with all college and F-1 immigration regulations. I
will complete at least 12 units each semester, withdrawals (W’s) do not count, for which I register thereafter. I am aware that
Sacramento City College’s nonimmigrant admissions and continued attendance is contingent upon full evaluation of SCC
International Admission Packet, payment of nonresident tuition fees at the time of registration and proof of health/ medical
insurance coverage. I accept self-responsibility to visit www.uscis.gov
and to follow F-1 regulations affecting my status. I
authorize the International Student Center Staff to provide any information to my financial sponsor(s) or information needed for
SCC. I authorize ISC to access my I-94 record (record of legal entry to the U.S. as a F-1 student) for purposes of maintaining my
immigration status.
Signature of applicant__________________________________________________________ Date_______________________
STATEMENT OF EDUCATIONAL GOAL
STATEMENT AND SIGNATURE OF APPLICANT
FOR STUDENT UNDER 18 YEARS OF AGE
Revised 02/2020
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F-1 Student Data Form (Sacramento City College)

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Completed 5 September 2020

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