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This application is for international students only.  U.S. citizens or immigrants should visit for application information.


Name as Printed on Passport (in English)

Last/Family Name:
First/Given Name:
Middle Name:
US address (if known)
Street Address:
City/State Country:
Postal Code  
Telephone: Fax:
Home Country Information and Email Address
                        Email Address:
Street Address:
City/State Country:
Postal Code    
Telephone: Fax:
Country of birth: Country of

Date of Birth (month/day/year):

Marital Status:
List spouse and /or children who will accompany you to the United States.
Birth Date (mm/dd/yy):
Relationship to Applicant:
Birth Date (mm/dd/yy):
Relationship to Applicant:
Birth Date (mm/dd/yy):
Relationship to Applicant:
Educational Interests
Starting Quarter: Year:
How long do you plan to attend HCC?   
Desired program of study:
University Transfer Program Major:
Train for a career/complete a certificate or 2-year program 1 year (Certificate)
2 year (AAS Degree)
Short Study Program (up to 12 months of study - non-degree seeking)
Prepare for a Master's degree/MBA program
Complete high school
Prior education upon entry to HCC
What was the language of instruction at your  high school?
Name of last high school attended: City:
Yes No
Years Attended:
Have you attended university? No
Years Attended:
What  university did you attend?
Did you graduate from university? No
Year Graduated:
Have you taken your TOEFL exam?
Yes No
Test date:
TOEFL Score:
Have you taken another English proficiency exam?  If yes, which one? Test Score:
Visa Information
Do you currently have a valid U.S. Visa?
Yes No
If yes, what kind?
F-1 M-1
J-1 Other: 
If you are currently studying in the U.S.:
What institution issued your I-20?
Where are you
currently studying?
Current SEVIS ID from I-20 Form:

expiration date:

Have you applied for permanent residence (green card)? Yes No
Do you plan to travel outside the United States prior to the beginning of the quarter?
Yes No Don't know yet
If yes, please indicate date and location of travel:
Date (mm/dd/yy):


Medical Insurance and Permission to Provide Services in Cases of Emergency
   I agree to purchase and maintain adequate medical insurance while attending Highline College. The College assumes no responsibility for verifying the standards of coverage if purchased outside the College's plan. The named student has nomedical restriction that limits his/her full participation in the programs and activities of Highline College, except as disclosed in any writing attached to this document.
Permission to provide services in case of emergency.  

In the event of an emergency, I hereby give full authority and permission to Highline College, its officers, employees, agents and host families to take whatever action is reasonablywarranted under the circumstances, and to act as agent of the student and parent/guardian regarding the student's health and safety. I agree that in the event of a medical emergency Highline College may refer the student below to a licensed medical practitioner and/or clinic and hereby consent that such physician, hospital, or clinic may treat the student in response to the medical emergency. I  also hereby authorize that a photocopy of this authorization be accepted with the same authority as this original. This authority and permission includes, but is not necessarily limited to, the following: Rendering or ordering medical treatment; the giving of medication; and any examinations, x-rays, anesthetic, medical or surgical diagnosis or treatment or hospital care, if and as deemed necessary.

I understand that a reasonable attempt will be made to contact the parent/guardian or emergency contact before any action is taken.

I agree to be financially responsible for all medical attention so authorized or ordered during the student's attendance at Highline College.

I give permission for the student to participate in all activities offered at Highline College, except as restricted in any attached writing. To the fullest extent permitted by law, the I hereby release Highline College, its officers, employees, agents, and host families from all liability, and waive and release all claims, related to or arising from such decisions or actions as may be taken under the authority of this document.

I  agree to provide emergency contact information to Highline College's International Student Programs office prior to the first date of study, and to update this emergency contact information upon request.
Sponsorship/Financial Statement
How will you pay for your tuition and living expenses? My Own Funds
Family Funds
Company Scholarship

To be signed by the sponsor/person responsible for the student's financial obligations.

In signing this document, I hereby agree to be financially responsible for (please type student's name) while attending Highline College. I understand that the expenses outlined here are estimates and are subject to change.

Sponsor's name
Relationship to applicant:
Type your name in the box below to indicate your agreement to pay all educational expenses for this student.

Sponsor's signature

Sponsor's address (please include city and country):
I have read and agree that all statements I have provided in this document are  true and correct. (Type full name):

Student's signature:

*My signature above authorizes Highline College to release academic records and immigration status information to my parents, educational agency, and/or sponsor.            I decline to authorize release of this information 

Students under the age of 18 must also have their parent/guardian's signature.

Parent/Guardian's Signature:


Please print a copy of this application for your records
BEFORE  you click the button below.

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