International Student Application

To apply for admission to Rogue Community College, complete and sign this form and it will be automatically sent to the RCC Enrollment Services office. Contact an International Advisor 001-541-245-7574 for information on limited enrollment programs, admission requirements for specific programs, or for the status of your application.

Personal Information

First Name *

(As it appears on your passport)

Middle Name

Last Name *

(Family name, as it appears on your passport)

Previous Name

Age *

Date of Birth *

Month / Day / Year

Sex *

Male

Female

If yes, SSN:

Email Address *

Street Address *

(Street address in your home country)

City or Town *

State *

Postal/Zip code *

Country *

Phone Number *

(Include Country Code)

Country of Birth *

Country of Citizenship *

U.S. Residence and Contact Info

U.S. Mailing Address

City

State

Zip

U.S. Phone Number

Are you currently attending an U.S. high school or college? *

Yes

High School Education Information

High School Attended *

High School Location *

Grade Completed *

Last Date Attended *

Date Graduated *

College Education Information (if applicable)

College Attended

College Location

Years Completed

Last Date Attended

Date Graduated

Signature *

I certify that all statements on this application are complete and true. I also understand that if I am admitted and do not enroll for the term to which I am admitted, I will need to reapply for admission; RCC Placement test scores must be on file in Enrollment Services Office before I enroll for classes at RCC; Submitted materials will not be returned and/or duplicated.

Date *

Month

Day

Year

Family Information

Parent Name (choose one) *

Parent's Address

Parent's Phone Number

Friends/Relatives in USA

Friend/Relative Name (#1) *

Friend/Relative Address (#1) *

Friend/Relative Phone (#1) *

Friend/Relative Name (#2) *

Friend/Relative Address (#2) *

Friend/Relative Phone (#2) *

Emergency Contact in Home Country

Emergency Contact Name *

Emergency Contact Address *

Emergency Contact Phone *

Emergency Contact in U.S,

U.S. Contact Name *

U.S. Contact Address *

U.S. Contact Phone *

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Rogue Community College does not discriminate in any programs, activities, or employment practices on the basis of race, color, religion, ethnicity, use of native language, national origin, sex, sexual orientation, gender identity, marital status, veteran status, disability, age, pregnancy, or any other status protected under applicable federal, state, or local laws. For further policy information and for a full list of regulatory specific contact persons visit the following webpage: www.roguecc.edu/nondiscrimination.

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International Student Application