ELCP Application Form
To apply for our program, print out the Application Form and Financial
Resources Statement below and mail them to:
1121 - ELCP
Admissions
Lansing Community College
P.O. Box 40010
Lansing, MI 48901-7210, U.S.A.
Telephone: (517) 483-1200
Name_____________________________________________________________
Family
First
Middle
Home Country ________________________________
Birth date ____________________________________ Sex: ____ Male
____ Female
Month/Day/ Year
Address _______________________________________________________________
_______________________________________________________________
Telephone ____________________________________
E-mail _______________________________________
Fax__________________________________________
Country of Birth _______________________________
Passport Issued By ___________________________
Passport Expiration Date _______________________
I wish to begin study: (check one)
____ Spring I (January)
____ Summer (June) ____ Fall I (August)
____ Spring II (March)
____ Fall II (October)
I wish to study ______ (1-5) sessions.
(5 sessions is equal to 1 year of study)
Previous Education
_____________________________________________________________________
High school
Graduation date
_____________________________________________________________________
College/University Graduation
date
TOEFL Score: ____________________________________
(if available)
After leaving ELCC, I plan to: (check
one)
____ Return to my country ____ Transfer to another college
____
Enter an academic program at Lansing Community College
|
If you are currently in the United States, Visa Type ______ I-94 Departure Record Number ____________ I-94 Expiration Date_______________________ U.S. Address
_______________________________________________________ Telephone _______________________
Fax ________________________ F1 students: Attach a copy of your current I-20 form (font and back). |
The above information is correct and complete to the best of my knowledge.
___________________________________________________________________
Applicant's Signature
Date Submitted
FINANCIAL RESOURCES STATEMENT
(For International Students desiring F-1 Visa)
To comply with USINS regulations, Lansing
Community College must have assurance of full financial support for your entire
program of study before admission can be granted. Complete this form and
attach supporting documents.
Student
Name______________________________________________________
Family
First Middle
|
Anticipated Yearly Financial Resources in U.S. Dollars |
Year 1 |
|
Your personal funds (attach bank statement in English) or family funds (complete certification of financial support below and attach bank statement) |
$ |
|
U.S. Sponsor (must complete I-134, Affidavit of Support.) |
$ |
|
Other Sources-example: scholarships from home country (must complete support certification below and attach supporting documents) |
$ |
|
Total (Minimum required $19,000) |
$ |
CERTIFICATION OF FINANCIAL SUPPORT
Important Note: U.S. sponsors -- Do NOT use this form. You must
use form I-134, Affidavit of Support. (Available from USINS or the LCC
International Programs Office)
1.
The family or agency responsible for paying all educational, living, and
other expenses while the students is in the United States must complete and sign
this form. If you have more than one sponsor, each sponsor must complete
this form.
2. Attach supporting documents in English. Individual sponsors must substantiate their ability to support the student by attaching an original bank statement specifying the exact amount currently on deposit. Sponsoring agencies must attach an official agency letter explaining the details of the scholarship, including conditions and amounts of the award. Please note: Photocopies are not acceptable and documents cannot be dated more than six months prior to date of application.
I/We
_______________________________________guarantee to finance the education of
(Name of sponsor)
_____________________________ in the amount
of _____________U.S. Dollars per year
(Name of Student)
as long as he/she is enrolled at Lansing Community College.
_____________________________________________________________
Signature of parent/guardian/agency
Relationship to Applicant
Sponsor's complete name (printed)
______________________________________________________________
Sponsor's mailing address
______________________________________________________________
______________________________________________________________
Center for Transitional Learning Department
Arts and Sciences Bldg, Room 253
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