Application for Admission to Sinclair Community College
Dayton, Ohio, U.S.A.
on the F-1 Nonimmigrant Visa

Please PRINT and return the completed application to the Office of Registration & Student Records, Sinclair Community College, 444 West Third Street, Dayton, Ohio USA 45402-1460.A one-time, non-refundable $10.00 application fee will be assessed at the time of registration. DO NOT SEND PAYMENT WITH THE APPLICATION.

Social Security Number ____________________________ Name ______________________________________________

Print complete mailing address including city, state or province, country, and postal code, if any:
Permanent Home Address_____________________________________________________________________________________________
Permanent Telephone Number ___________________________________(Include country and city code)

Print complete mailing address including street, city, state, and zip code
U.S. Address (if known)_____________________________________________________________________________________________
U.S. Telephone Number_______________________________________(Include area code)


Name, Address, and Telephone Number of Person to Contact in an Emergency ___________________________________________________
________________________________________________________________________________________________________________________

Gender/Sex ____Male ____Female (check your answer)
Birthdate ___________________(Month/Day/Year) Country of Birth_____________________ Country of Citizenship____________________

Nonimmigrant Visa/Status you have now, if any (check your answer) ____B1/B2 ____F1 ____F2 ____Other (write in visa type: A, E, H, etc.)
Attach photocopies of both sides of your current I-94 and identification page and US visa page of your passport, and I-20, if on F1 status.

Are you applying to enroll full time at Sinclair Community College on the F-1 nonimmigrant visa? ____yes ____no (check your answer)

Is English your native language? ____yes _____no (check your answer)

Are you married? ___yes ___no (check your answer) Will your spouse and/or children be traveling to the U.S. with you? ___yes ___no (check your answer)
If yes, indicate how many family members will come with you to the U.S. ___________________ (write in number)


Program of Study (Major) you plan to follow at Sinclair _____________

What is your primary educational plan at Sinclair?  (Check one only)
__ To obtain an associate degree for the job market (01)
__ To obtain an associate degree then transfer to a four-year college or university (02)
__ To obtain a certificate (03)
__ To transfer to a four-year college of university before completing a degree or certificate (04)
__ To train for a new career by taking only selected courses (05)
__ To upgrade current job skills by taking only selected courses (06)
__ To obtain knowledge for personal interest (07)


High School/Secondary School from which you graduated ________________________________________(list full name, city, and country)
Date of graduation _______________________________________________________ (list month and year of graduation)
(Send official or certified copy of transcript and verification of graduation plus certified English translation, if applicable, with your application.)

List all Colleges or Universities that you have attended:
Name of College or University City, State, Country Dates Attended Were You Academically Dismissed? (MO/YR - MO/YR)
__________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________

I certify that the information I have provided on this application is complete and accurate to the best of my knowledge. I understand that misrepresentation of facts on this application may be cause for refusal of admission, cancellation of admission, or suspension from the college. By signing this application, I agree to abide by the policies and regulations of the college.
__________________________________________________________________________________________________________________________
Signature & Date Signed

rev: 7/98