Instructions for preparing form

1. Please read entire form before answering the questions.
2. Please print clearly in ink or typewrite.
3. Answer every question. Write N/A (not applicable) where appropriate.
4. Send completed form directly to:

   Registrar
   Danville Area Community College
   2000 East Main St
   Danville IL 61832

   or Fax to 217.443.8337

1. Name
Mr.   Ms.   Mrs.   Miss
	____________________	____________________	____________________
	Family Name	First Name	Middle Name
2. Birthdate	____________________	____________________	____________________
	Month	Day	Year

II. EDUCATION PLANS
 

1. Semester you wish to begin?      Fall _____  Spring _____  Summer _____    Year _____

2. Curriculum you would like to study ________________________________________

III. SCHOOL AND UNIVERSITY RECORD:
(Give names of schools and dates of attendance.)
 

1. Primary school _________________________	From ________	To ________
	M / Y	M / Y
2. Secondary school _________________________	From ________	To ________
	M / Y	M / Y
3. University _________________________	From ________	To ________
	M / Y	M / Y

IV. EXAMINATIONS
 

1. College Entrance Examination Board (SAT and ACT)
If you have taken any of these tests, please specify which tests and the dates below.
_________________________	Date _________________________
_________________________	Date _________________________

V. LANGUAGES
 

1. What language(s) do you speak at home?  _________________________

2. How many years have you studied English?  _________________________

3. When did you or when do you plan to take the Test of English as a Foreign Language (TOEFL)?

4. Total Score on TOEFL (If it is known)  _________________________

5. Have you studied English in the United States?   Yes____       No____

If yes, where did you study?  _________________________

VI. PERSONAL INTERESTS

• You may use the space below to describe your interests and activities which are not associated with your academic work, but which you consider to be important and significant in your life.
• Mention those interests which you will probably continue to pursue while studying in the United States.
• If you have left school and are employed, please describe your work experience.

BE CERTAIN TO SIGN BELOW
Please sign this document, indicating that all of the above statements are, to the best of your knowledge, true.

Signature ___________________________________________

1. You are required to certify that you will have available the sum of $11,450 per year for your own expenses for your first academic year at Danville Area Community College, exclusive of travel expenses.
2. You should also indicate how you will meet your expenses for subsequent years of study if you expect your program to require more than one year.
3. Students who plan to stay in the United States through one summer will need an additional $1,000 (US) for that period.
4. In computing expenses, you should remember that students holding visas will not be authorized to work off-campus for the first year. Students are eligible to find on-campus employment (maximum of 20 hours per week) during that first year.

PLEASE NOTE: A FORM I-20 (for issuance of a visa) cannot be issued to you until you have been admitted to Danville Area Community College and have completed this form to our satisfaction and returned it to this office.

This is to certify that I have read the information furnished by the applicant on this form, that it is true and accurate, and that the funds are available and will be provided as specified.

Bank Official's Signature  ______________________________

Bank Official's Name (printed)  ______________________________

Bank Name  ______________________________

Address  ______________________________
              ______________________________
              ______________________________

Date  ______________________________
 

This is to certify that I have read the information furnished by the applicant on this form, that it is true and accurate, and that the funds are available and will be provided as specified.

Sponsor's Signature  ______________________________

Sponsor's Name (printed)  ______________________________

Relationship of Sponsor to Applicant  ______________________________

Address  ______________________________
              ______________________________
              ______________________________

Date  ______________________________
 

I, _____________________________________ certify that the total amount of money that I have available for my first academic year of study at Danville Area Community College is ______________ US$. Further, I certify that the above information provided is correct and complete.

Applicant's Signature ________________________________________
Date _______________________