FLORIDA GATEWAY COLLEGE 149 SE COLLEGE PLACE LAKE CITY, FLORIDA PHONE: FAX:

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1 FLORIDA GATEWAY COLLEGE 149 SE COLLEGE PLACE LAKE CITY, FLORIDA PHONE: FAX: INTERNATIONAL STUDENT APPLICATION FOR ADMISSION ADMISSION APPLICATION PROCEDURES: International students who enter the United States under a nonimmigrant student Visa will be admitted for specified terms only. A FGC Certificate of Eligibility I-20 form will be issued only after ALL of the following documents have been received in the Office of Admissions. Please mail complete application packet to the FGC Office of Admissions at the address noted above. Name: Last (Family) First (Given) Middle ADMISSION REQUIREMENTS: 1. FGC International Student Application for Admission Please submit a completion application for admission providing all required documents in one complete packet. An incomplete application will not be processed. 2. Certificate of Financial Responsibility You must provide proof of funds for your first year tuition and living expenses before we can issue the required Form I-20 you will need when applying for your F-1 or M-1 Visa. The current international student estimated expenses for 12 months is 25,000 U.S. dollars ($25,000.00). 3. High School Equivalency Education All foreign education transcripts must be translated and evaluated by a National Association of Credential Evaluation Services (NACES) approved foreign credential evaluation and translation service provider. An official report must be submitted from the evaluating agency directly to Florida Gateway College/Attn: Office of Admissions. 4. College or University Level Courses - All transfer-in College and/or University transcripts must be translated and evaluated by a National Association of Credential Evaluation Services (NACES) approved foreign credential evaluation and translation service provider. A detailed course-by-course evaluation must be completed and submitted from the evaluating agency directly to Florida Gateway College/Attn: Office of Admissions. 5. TOEFL Scores If English is not the native language of your country you will be required to present TOEFL scores that are less than two (2) years old. The minimum official scores which are acceptable for admission are as follows: Paper-based test: 500; Computerized-based test: 173; and the internet-based test is All Students All students must report to the Admission s Office upon arrival to meet with the International Designated School Official (DSO). Students will need to present all immigration documents and their passport. This will include the Form I-20 and Form I-94. International students are required to have student medical insurance which will cover medical costs while in the U.S. Students will be required to provide proof of medical insurance coverage upon arrival. First-time college students are required to take an entry level college placement test such as the ACT, SAT or PERT. This must be done prior to registration for courses. If you have not taken one of these tests or do not have official test scores, you will be required to take a placement test upon arrival, before meeting with an academic advisor. Tuition and fees are due at the time of registration and may be paid in cash, check or money order in U.S. currency. Florida Gateway College is a member of the Florida College System. Florida Gateway College is accredited by the Southern Association of Colleges and Schools Commission on Colleges to award the baccalaureate and associate degrees. Contact the Commission on Colleges at 1866 Southern Lane, Decatur, Georgia , or call for questions about the accreditation of Florida Gateway College. The Commission is to be contacted only if there is evidence that appears to support an institution s significant noncompliance with a requirement or standard. FGC will adhere to all applicable federal, state, and local laws, regulations, and guidelines with respect to providing reasonable accommodations as required to afford equal educational opportunity. Students may obtain further assistance and information by calling Janice Irwin, coordinator of disability services, at (386) The Disability Services Office is located in Building 017, Room 021, 149 SE College Place, Lake City, Florida Florida Gateway College does not discriminate in education or employment related decisions on the basis of race, color, religion, national origin, gender, age, disability, marital status, genetic information, or any other legally protected status in accordance with the law. The Equity Officer is Sharon Best, director of human resources,149 SE College Place, Lake City, FL 32025, and may be reached at (386)

2 PLEASE COMPLETE ALL SECTIONS IN FULL (please print): PERSONAL & IMMIGRATION INFORMATION (SEVIS Student Data) Do you have a U.S. Social Security Number: Yes No If yes, what is your SS# - - NOTIFICATION OF SOCIAL SECURITY NUMBER COLLECTION AND USE: In compliance with and pursuant to Florida Statute (5), , (2), and SBE Rule 6A (3) (e), Florida Gateway College (FGC) issues this notification regarding the purpose of the collection and use of your Social Security number. FGC collects your Social Security number for use in performance of the college s duties and responsibilities. In a seamless K-20 educational system, it is beneficial for postsecondary institutions to have access to the same information for purposes of tracking and assisting students in the transition from one educational level to the next. Federal legislation relating to the Hope Tax Credit requires that all postsecondary institutions report the Social Security number of all post-secondary students to the Internal Revenue Service (IRS). This IRS requirement makes it necessary for colleges to collect the Social Security number of every student. A student may refuse to disclose his/her Social Security number to the college, but refusing to comply with the federal requirement may result in fines established by the IRS. Providing your SSN on this form signifies that you consent to the use of your number in the manner described. To protect your identity, FGC will secure your Social Security number from unauthorized access. FGC will never release your Social Security number to unauthorized parties, and each student at FGC will be issued a unique student identification number. Your unique student identification number is used for all educational purposes at FGC including registration, access of your online record, etc. All Social Security numbers are protected by federal regulations and are never released to unauthorized parties. For additional detailed information on the college s collection and use of social security numbers, please visit the college s website at Name: Mailing Address (Outside of the U.S.) : Number and Street/Apt.# (required for I-20 processing) City County/State/Region/Province Postal Code Country Telephone Number address Mailing Address (United States): City State Zip Code Telephone Number (include area code) address Date of Birth: / / Gender Female Male Primary Language Month Day Year Country of Birth Country of Citizenship Will you bring dependents to the U.S.? Yes No Number of dependents: (list dependents on page 2 of application) Are you currently in the U.S.? Yes No If yes, what date did you enter the U.S.?: / / Month Day Year VISA HOLDERS: Will you exit and re-enter the U.S. if issued an I-20? Yes No Type of Visa: Expiration Date: / / I-94 Number: Are you transferring from another U.S. school? Yes No Name of School: If accepted, please indicate address where the acceptance letter and I-20 form should be mailed: United State (address listed above) Outside the United States (address listed above) Pick Up in Person by: Other: Emergency Contact: Telephone: City State/Region/Province Postal Code Country

3 EDUCATIONAL PLAN: INTENDED STARTING DATE: Fall Spring Summer Year: Please enter the degree code which corresponds to your educational plan. Majors/Courses of Study can be found at I plan to complete one of the following: Earn a Certificate and/or Applied Technology Diploma: Earn an Associate in Arts (university transfer). Earn an Associate in Science degree (may not transfer). Earn a Bachelor s Degree at Florida Gateway College. Have you taken the TOEFL test? Yes No If yes, please list your test scores below. You must submit your official test scores with your application. Computer Test: Paper Test: Internet Based:. If you have not taken the TOEFL when do you plan to take the exam? / /. HIGH SCHOOL/COLLEGE INFORMATION: All foreign educational transcripts must be evaluated by a NACES approved academic credential evaluating agency. All transfer-in College and/or University transcripts must be translated and evaluated with a course-bycourse evaluation conducted. The official evaluation/report must be submitted from the evaluating agency directly to FGC - Attention: Office of Admissions. Name as it appears on high school records: Name of High School: Location: Graduation Date: / / City County/State/Region/Province Country Month Day Year Were examination scores required for graduation? Yes No Do you have verification: Yes No COLLEGE/UNIVERSITY INFORMATION: List all colleges or universities that you have attended. Do not abbreviate school names. Attach an additional sheet if necessary. Please do not include non-credit English language study. COLLEGE/UNIVERSITY LOCATION YEARS ATTENDED DEGREE EARNED DEPENDENT INFORMATION: If bringing dependents, please include the following information on each. Attach an additional sheet if necessary. Please print. Last (Family) Name First Name Middle Name Date of Birth Relationship How did you hear about Florida Gateway College? Internet Friend/Relative Publication Other I hereby apply for admission to Florida Gateway College as an international student. I have checked the application for error and certify that the information is accurate and complete. I agree to abide by all rules and regulations of the College. I understand that in addition to this application I must submit all required documents to be considered for admission. Applicant s Signature: Date Signed:

4 FLORIDA GATEWAY COLLEGE F-1 Visa Applicants CERTIFICATE OF FINANCIAL RESPONSIBILITY The United States Citizenship and Immigration Services require Florida Gateway College to obtain documentary evidence of financial support of all applicants for an F-1 visa. The Affidavit of Financial Support verifies that the student has sufficient funds to support themselves while studying in the U.S. The student, sponsor or other sponsoring agency must prove that a minimum of $25,000 (U.S. dollars) per year is available for tuition and living expenses. Applicants must submit valid supporting documents verifying access to the funds. ESTIMATED EXPENSES (in U.S. currency): Current international student estimated expenses for 12 months or two (2) semesters (fall & spring) of study at 12 semester credit hours per term. Please note: these amounts are subject to change. TUITION:$10,000 BOOKS AND SUPPLIES: $3,000 LIVING EXPENSES: $12,000: TOTAL: $25,000 The above amounts are based on the assumption that a student is careful in the use of his/her funds, does not plan to purchase an automobile and has no dependents. Students must have sufficient funds to pay for their tuition in full at the time of registration each term. APPLICANT INFORMATION: Name: Date of Birth: / / Country of Citizenship: Number of Dependents: Additional resources required for each dependent Enrollment Plan: Certificate/Applied Technology Diploma Associate s Degree Bachelor s Degree SOURCES OF SUPPORT REQUIRED DOCUMENTS GUARANTEED SUPPORT IN U.S. DOLLARS Personal Funds (Liquid Assets *Official Bank Documents plus the Affidavit of $ Required) Support Section Below Parent or Sponsor *Official Bank Documents plus the Affidavit of $ Support Section Below Government or Sponsoring Agency Original or certified copy of award letter. $ Scholarship or Other Source: *Official Bank Documents and/or validated documentation from an authorized person of $ financial guarantee. Letter must state amount of support and period of coverage. TOTAL $ *Official Bank Documents Original of official bank document signed by a bank official reflecting enough funds to cover the total estimated expenses (per year) related to your educational objective (see above). Photocopies of bank documents are unacceptable. FEES ARE DUE AT THE TIME OF REGISTRATION.

5 I hereby certify that the information on this form is true and accurate and that the stated funds are available for my educational expenses (note: medical insurance and dependent expense is not included). I understand that the submission of inaccurate information can be considered sufficient cause for rejecting my application and terminating my enrollment at Florida Gateway College. Applicant s Signature: Date Signed: SPONSOR INFORMATION: NAME: Mailing Address: Number & Street/Apt # City County/State/Region/Province Country of Citizenship: Postal Code Country (Citizens or U.S. legal permanent resident must complete USCIC Form I-134) AFFIDAVIT OF FINANCIAL SUPPORT - To be completed by a parent, family guarantor, or applicant even if support is personal funds. This is to certify that I have read the information furnished by the student listed above and that I am willing and able to support him/her while enrolled at FGC. I certify that I can provide the amounts noted below for each year of enrollment. I have enclosed an official bank letter certifying the availability of funds as reflected below. ALL FUNDS MUST BE NOTED IN U.S. DOLLARS FEES ARE DUE AT THE TIME OF REGISTRATION. 1. Name of Sponsor/Guarantor (Please print) Amount of Support I will provide: $ in U.S. currency. Signature of Sponsor/Guarantor Mailing Address: Phone Number: Relationship to Student: 2. Name of Sponsor/Guarantor (Please print) Amount of Support I will provide: $ in U.S. currency. Signature of Sponsor/Guarantor Mailing Address: Phone Number: Relationship to Student: Rev 6/2014