EVC International (F-1) Student Program Application Page 1 of 5 Revised 03/08/18

International Student Program (ISO)

Evergreen Valley College

3095 Yerba Buena Road

San Jose, CA 95135

Room SC 201

Tel: 001.408.223.6740

International@evc.edu

International Student Program

Application

Packet

Applicant’s Name:

Intended Starting Term:

Telephone:

Email:

EVC International (F-1) Student Program Application Page 2 of 5 Revised 03/08/18

International Student Application Checklist It is the applicant’s responsibility to check if all documents required are prepared for submission.

Applicants should be aware that incomplete application WILL delay the admission process.

1. International (F-1) Student Application (see pages 3-5)

2. EVC College Application ONLINE

https://www.opencccapply.net/uPortal/f/u66l1s1000/normal/render.uP

Note: for the above forms, all requested information must be filled out completely, and a U.S. address

must be provided for SEVIS, as required by USCIS.

3. Two color photos (passport type)

4. Transcripts from your high school/colleges

5. TOEFL or IELTS, scores MUST be sent directly by testing agency. School code: 4273

TOEFL: Minimum score based on test type: 500 – paper based exam; 173 – computer based exam; 61

–Internet based exam.

IELTS: Minimum Band Score: 6.0

If the applicant has completed degree applicable courses in English with a grade of “C” or better (at an

accredited U.S. college/university), the TOEFL or IELTS may be waived.

TOEFL exemption applies to native English speakers such as the United Kingdom, Australia, New

Zealand, and Canada (except Quebec) where English is both the only official language of the country

and the language of instruction.

6. Original Bank Verification (signed by a certifying official) with minimum balance of US$20,000 from

parent(s) or a sponsor dated within 6 months of application date.

7. Letter of Financial Support or Affidavit of Support form from a parent or a sponsor

8. Copy of passport biographical information page

9. TB Skin Test results. If results are positive, a chest x-ray will be required. Exams must be dated within 6

months of application date.

If applying for admissions in the U.S., in addition to the above-listed, the following items are also required:

10. Copy of your current visa, Information pages and I-94 Card from your passport

11. If you are currently on an F-1 Student Visa:

i. Copy of your Form 1-20

ii. Transcripts from current school

iii. Transfer authorization letter from the current school (may be provided upon acceptance)

Evergreen Valley International Student Program (ISP)

Tel: 001.408. 223.6740

international@evc.edu

Evergreen Valley College

3095 Yerba Buena Road,

San Jose, CA 95135

www.evc.edu

EVC International (F-1) Student Program Application Page 3 of 5 Revised 03/08/18

International (F-1) Student Application

International Student Program (ISP)

Evergreen Valley College

3095 Yerba Buena Road,

San Jose, CA 95135

Tel: 001.408. 223.6740

international@evc.edu

I am applying for:

FALL 20_________

Spring 20________

NAME Last (Family) as appears in your Passport First (Given) Middle

Date of Birth (mm/dd/yy) Female Male Primary Language

Country of Birth Country of Citizenship

Degree / Program of Study (to view a complete listing, visit: http://www.evc.edu/AcademicAffairs/Documents/degrees-certificates.pdf

Number and Street Number and Street

City City

State/Province/Prefecture State/Province/Prefecture

Country Postal Code Country Postal Code

Cell /Tel # (include country code) Cell /Tel # (include country code)

Preferred E-Mail Address

Home Country – Permanent Address: Local/ U.S. Address (not a P.O. Box):

Where would you like your I-20 and acceptance letter mailed? Check one box only

Home/Permanent Local/Current Agency name:

Other, shown below:

Contact Person

Complete Address

Phone # & E-mail Address

Evergreen Valley

EVC International (F-1) Student Program Application Page 4 of 5 Revised 03/08/18

REFERRAL SOURCE/AGENT INFORMATION

How did you learn about Evergreen Valley College (EVC)?

EVC website Referring agency Fair/Seminar Advertisement Friends/Relative

If the application is submitted by an education advising agency, please complete the following:

Agency Name: _______________________________________ Contact Person’s Name: ___________________________

Email Address: ________________________________________ Phone Number: __________________________________

Address: _______________________________________________________________________________________________________

If you are in the U.S. now, please indicate your current visa type: ________________________________________

Date of entry into the U.S.: _____ / _____ / ______ Visa Expiration Date: _____ / _____ / _______ Month Day Year Month Day Year

If you don’t have F-1 visa, where will you be applying for it? Within the U.S. From your home country

If currently on an F-1 visa, what institution issued your Form I-20? ________________________________

ENGLISH PROFICIENCY:

TOEFL Test __________ (score) IELTS Test _________ (score)

Test Date: _____ / _____ / ______ Test Date: ______ / _____ / ______

Month Day Year Month Day Year

EDUCATIONAL BACKGROUND: (please list your high school and any college attended)

High school Attended City/Country Date Completed Diploma

University/College Attended (If any) City/Country Date Completed Diploma/Degree

TO BE COMPLETED BY STUDENTS CURRENTLY STUDYING IN THE UNITED STATES ONLY

Name of U.S. school you are currently attending City/State Date Started

MARITAL STATUS: Single Married

Will Spouse/Children Accompany you to the U.S? YES (additional documentation/finances will be required) NO

Name Relationship to Applicant

EVC International (F-1) Student Program Application Page 5 of 5 Revised 03/08/18

EMERGENCY CONTACT INFORMATION

This information will remain on file for the duration of your enrolment. If a change occurs, please report to the International

Programs & Services IMMEDIATELY.

Emergency Contact Person: ______________________________________________________________________

Address: ____________________________________________________________________________________

Telephone Number: ___________________________________ Mobile Number: __________________________

(include country code) (include country code)

E-mail: ________________________________________________ Relationship to Applicant _________________________________

Does this person speak English? NO YES

As an International (F-1) Student attending Evergreen Valley College, I understand that I am encouraged to participate

in a supplemental medical/emergency plan (to purchase and carry medical insurance). If I choose do not participate, I assume

personal liability for any accident, health, hospitalization an any/all other medical related expenses incurred by me while

attending EVC as an International Student. By signing this application, I am accepting all responsibility for my medical care and

expenses.

Evergreen Valley College does not accept potential applicants that have been dismissed or terminated from other U.S.

collegiate institutions for any reason. I hereby declare that I have never been dismissed or terminated by any other U.S.

collegiate institution.

If accepted to EVC, I will follow the Standards of Student Conduct and Compliance with U.S. Immigration Laws &

Regulations: The Role and Responsibility of the International Student that are published in the college catalog and website

respectively, and I understand that failure to do so would be grounds for dismissal.

I understand that, upon acceptance and arrival at EVC, students will be tested for English and Math proficiency in order

to be placed at appropriate course level. All classes are conducted entirely in English; therefore students without sufficient

placement may be referred to a language school/program until they are able to meet the standards necessary to successfully

complete the required courses for their educational program.

THE STATEMENTS MADE BY ME IN THIS APPLICATION ARE TRUE AND COMPLETE TO THE BEST OF MY

KNOWEDGE. I UNDERSTAND THAT ANY FALSIFICATION CONSTITUTES PERJURY AND MAY BE LEGAL BASIS

FOR DISMISSAL

Student Name (please Print)

Student Signature Date