Fayetteville Technical Community College



-212090-14414500Form APRELIMIARY APPLICATION FOR FOREIGN STUDENT ADMISSIONThe official language of this college is English and all forms and correspondence must be completed in English. PLEASE PRINT OR TYPE ALL INFORMATIONDate FORMTEXT ?????Full Name: FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????LastFirstMiddleMaidenMailing Address: FORMTEXT ?????Date of Birth: FORMTEXT ?????/ FORMTEXT ?????/ FORMTEXT ?????MonthDayYearAge: FORMTEXT ?????Sex: FORMCHECKBOX Male FORMCHECKBOX FemaleRace: FORMTEXT ?????Marital Status: FORMCHECKBOX Married FORMCHECKBOX Single FORMCHECKBOX Divorced FORMCHECKBOX Widowed FORMCHECKBOX OtherI plan to bring the following dependents with me. List and specify relationship to you.NameRelationshipAge FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Secondary High School AttendedName of SchoolCountryYear Graduated FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????College(s) AttendedName of SchoolCountryGraduatedYear and Date FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT ?????Language of instruction used at the college(s) (i.e. English, French, etc.) FORMTEXT ?????Circle highest year of completion: 678910111213141516 17Name and address of the person(s) most closely related to you in the Fayetteville area. If you do not have a relative in North Carolina, give name and address of your closest relative in the United States.NameAddress FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????TOEFL test scores: FORMTEXT ?????Religion: FORMTEXT ?????Your native language: FORMTEXT ?????Please check the appropriate box(es) where the English language is used in your environment. FORMCHECKBOX Family FORMCHECKBOX School FORMCHECKBOX Friends FORMCHECKBOX Work FORMCHECKBOX Reading FORMCHECKBOX TV FORMCHECKBOX Movies FORMCHECKBOX CommunityPrint Name: FORMTEXT ?????Applicant’s Signature:Dated: FORMTEXT ????? ................
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