International Student Application

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Section 1: Personal Information

*Family Name

*Given Name

*Sex Male Female

*Marital Status Single Married

Date of Birth Month Day Year

City of Birth

Country of Birth

Country of Citizenship

Native Language

Permanent home address

Address

City

Postal Code

Province and/or Territory (if applicable)

Country

Telephone Country Code Phone Number (city code/number)

WhatsApp Number (optional) Country Code Number

Email

Mailing address is different from home address

I expect to come to the United States Alone
With Spouse
With Child

Sponsor Information

Please list those individuals who will be responsible for your expenses while at Lake Land College. This includes tuition, housing, meals, insurance, etc. Anyone applying for in-district sponsorship should ask their sponsor to contact the director of international studies as soon as possible.

Name

Relationship to you

Address

City

State

Country

Postal Code

Phone

Email

Emergency Contact Info

Name

Relationship

Phone 1

Phone 2

Email

Emergency WhatsApp (optional) WhatsApp Country Code WhatsApp Number

Section 2: Visa Information

*Application TypeNew Student Transfer Student

If "transfer student", what institution?

Type of Visa Currently Held (if any)

If "other", please explain

Section 3: Education Background

List all secondary and post secondary institutions previously attended. Proof of secondary school completion with official certified transcripts translated into English must be submitted. List most current school, college, or university first.

School 1 School Name

Location

Attendance Date

School 2 School Name

Location

Attendance Date

School 3 School Name

Location

Attendance Date

Section 4: Academic Intentions

In English, please explain why you are choosing your particular field of study and how you intend to make use of your education in your home country.

Academic Intent

*My major field of study is

Start date of program

Section 5: English Language Proficiency

*Lake Land College requires that students who are non-native speakers of English demonstrate English language proficiency by providing a qualifying TOEFL Exam score. If, however, you do not have a qualifying TOEFL Exam score and need assistance with English, Lake Land College offers an Intensive English Language Program. Students can enroll in the IELP, in lieu of submitting a TOELF Exam score, prior to beginning their program of study.

I have taken the TOEFL or other language test before I attend Lake Land College.

Name of Test:

Score:

I have not taken the TOEFL or other language test and plan on entering the Intensive English Program at Lake Land College.
I have not taken the TOEFL or other language test and come from an English speaking country.
I have studied in the United States for at least one full academic year (high school or college) and understand that test scores are not required. My academic transcript will be reviewed instead.
I plan to take the TOEFL or other language test before attending Lake Land College.

Section 6: Health Insurance Information

Health insurance option I will purchase health insurance from Lake Land College.
I will provide proof of my own health insurance, valid in the U.S., upon arrival.

Section 7: Verification

I grant permission to Lake Land College to provide my sponsor with documents and/or information concerning my admission status.

Grant permission Yes
No

By submitting this application electronically, I certify that all information provided on this form is true and correct. I understand that the presentation of false information or failure to comply with Lake Land College's admission and registration procedures may result in my dismissal without the refund of any fees paid.

Section 8: How did you hear about Lake Land College?

(Please indicate all that apply)

From a recruitment agent or consultant? Please tell us the agent's name and contact information:

On a website? Please tell us the website:

In a printed magazine, book or paper? Please tell us the name:

At an event or college fair? Please tell us the event's name:

Friend, relative or other source of information? Please indicate:

Important Information Regarding F-1 Status Maintenance

I understand as an international student I must:

Keep my passport and immigration status valid;
Maintain a GPA of at least 2.0 or higher;
Enroll in at least 12 credit hours during the fall and spring semesters;
Not work without prior authorization from the Director of International Studies and the Department of Homeland Security;
Maintain current health insurance at all times;
File annual tax forms;
Notify the Director of International Studies of any changes in information, such as address or course of study.

Admission to the College does not ensure entrance into a particular course program of study since applicants may have to meet specific requirements.

Admission as a degree - or certificate-seeking student is based on Application certification on the Student Demographic Information form as well as required documentation, such as transcripts from high school, colleges or GED.

Application

I understand that withholding information requested on this form, or giving false information, may make me ineligible for admission to the College or subject to dismissal. With this in mind, I certify that the above statements are correct and complete.

Lake Land College does not discriminate on the basis of race, color, sex, age, religion, national origin, ancestry, disability, marital status, veteran status, sexual orientation, or any basis of discrimination precluded by applicable federal and state statutes in admission or access to or in treatment of employment in college programs and/or activities. The Director of Human Resources, Lake Land College, 217-234-5210, has been designated to coordinate compliance with non-discrimination requirements contained in implementing regulations of the Title VI of the Civil Rights Act of 1964, Title IX of the Education Amendments of 1972 and the Age Discrimination Act of 1975. The Coordinator of Student Accommodations, Lake Land College, 217-234-5259, is designated as the Section 504 Co-ordinate of the Rehabilitation Act of 1973.