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Stevens-Henager College
International Student Application

Please print clearly This information will appear on the SEVIS Form I-20 issued by the Department of Homeland Security. Please send all documents to the International Student Office: 383 West Vine Street Murray, Utah 84123 United States of America Telephone: +1 801 281 7620 Fax: +1 801 261 7458 Email: internationalservices@stevenshenager.edu

Attach a Recent Photograph Here

Personal Information
`

Legal Name_____________________________________________________________________________
As it appears on your passport (Family/Surname/Last) (Given/First) (Middle Name)

Male Female Single Married

Date of Birth (Day)_______ (Month)_______ (Year)_______ If you currently hold a valid U.S. visa in your passport, indicate type: F-1* B-2 Other U.S. Visa:_________________________ (If adding F-2 dependent(s) please complete the dependent information form)

*If you are currently an F-1 student transferring from another school/college in the U.S: Name of school that issued most recent SEVIS I-20: __________________________________________
SEVIS number: ________________________ Submit a copy of current I-20, I-94 card, F-1 visa, & passport

Place of Birth (City, State)_______________________________________ Country of Birth ________________________ Passport Number _______________________ Passport Date of Issue ___________________ Are you under 18 years of age? No Yes Country of Citizenship _______________________ Passport Place of Issue _______________________ Social Security Number ______________________
(If applicable)

(Students under 18 must complete a parental authorization form and submit with the application.)

Contact Information
Applicant Home Country Address_____________________________________________________________
(Number and Street no P.O. Boxes, Apartment #)

City____________ (State/Province) ____________ (Country) ____________ (Postal Code) ____________ Applicant US Address (if applicable)_____________________________________________________________
(Number and Street no P.O. Boxes, Apartment #)

City____________ (State/Province) ____________ (Country) ____________ (Postal Code) ____________ Home Country Telephone Number___________________ USA Telephone Number ___________________
(Country code and phone number) (Area code and phone number)

Students Email Address (required) ____________________________________________________________

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Stevens-Henager College
International Student Application

Emergency Contact Information

Name _____________________________________ Relationship __________________________________
(Mother/Father/Brother/Sister/ Other)

Address_________________________________________________________________________________
(Number and Street no P.O. Boxes, Apartment #)

City____________ (State/Province) ____________ (Country) ____________ (Postal Code) _____________ Telephone Number___________________ Email Address _______________________________________
(Country code and phone number)

List any family members who have previously or are currently attending Stevens-Henager College: _______________________________________________________________________________________

Program Interest
Indicate your intended start date:
t

January _____
(Year)

April _____
(Year)

June _____
(Year)

October _____
(Year)

Other ________ _____

(Month) (Year)

` programs start at various times throughout the year. If you know the specific start date, please write it in the Other Note: Many field above. If you do not know, choose the module within which you would like to begin.

Major: Please indicate the desired program of interest Graduate Programs Masters of Business Administration Masters of Healthcare Administration Masters of Nursing Administration Other ________________________________
(Indicate proposed major)

Undergraduate Programs Bachelors ____________________________

(Indicate proposed major)

Associates ____________________________
(Indicate proposed major)

Associate of Occupational Studies ____________________________

(Indicate proposed major)

Educational Background
Degrees completed: Associates Bachelors University/College City, Country Masters Dates of Attendance Some college credit earned Diploma/ Date Certificate/Degree Received

If you have not graduated, indicate expected graduation date in date received column. Prior credits and education will be verified at a later date. Indicate approximate credits taken, if applicable.

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Stevens-Henager College
International Student Application

Sharing Information
Please note: for your protection, information about your application status CANNOT be shared with anyone without your approval. Indicate a name below if you want someone else (parent, relative, friend) to receive this information. _________________________________________________________________________
Persons name (Family/Surname/Last) (Given/First)

Agent Information
If the application is submitted by an education advising agency, complete the following: Agency Name _________________________________________________________________________ Contact Person Name _______________________ Email Address _______________________________ Telephone Number _________________________ Fax Number ________________________________ Address _____________________________________________________________________________ City____________ (State/Province) ____________ (Country) ____________ (Postal Code) ___________

Certifying Statement
By signing below, I am certifying that no promises or explanations regarding these programs have been made to me by persons or agencies representing Stevens-Henager College that are inconsistent with any conditions and agreements presented. I certify that all of the information I have furnished is complete and accurate. I understand the disclosing false information or failure to comply with Stevens-Henager Colleges admissions and registration procedures may result in my dismissal without a refund of any fees paid. I understand that if I apply through an agency, the college may release information/other issues about my application to the agency. ________________________________________
Name as it appears on your passport (Print Name)

__________________________
(Signature)

________________
(Date: Day/Month/Year)

Admissions Procedure
All documents must be original or certified; no fax copies will be accepted. Applications will not be reviewed until the International Student Office has received all documents: Application Fee (if applicable) Application Form Financial Documentation Resume/Curriculum Vitae (CV) Proof of Diploma/Certificate/Degree Acknowledgement Form Personal Statement Copy of Passport(s) Two Letters of Recommendation Evidence of English Proficiency Official Transcripts

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Stevens-Henager College
International Student Application
DEPENDENT INFORMATION FORM (FOR F-2 VISA)

Applicant Information Applicant Name _________________________________________________________________________

As it appears on your passport (Family/Surname/Last) (Given/First) (Middle Name)

Do you plan to bring a spouse to the United States? Do you plan to bring a child/children to the United States? Dependent Information Spouses Name_____________________________________________________________________________
As it appears on passport (Family/Surname/Last) (Given/First) (Middle Name)

Male Female

Date of Birth (Day)_______ (Month)_______ (Year)_______ If you currently hold a valid U.S. visa in your passport, indicate type: Country of Citizenship _______________________

Country of Birth ________________________

Childs Name_____________________________________________________________________________
As it appears on passport (Family/Surname/Last) (Given/First) (Middle Name)

Male Female

Date of Birth (Day)_______ (Month)_______ (Year)_______ If you currently hold a valid U.S. visa in your passport, indicate type: Country of Citizenship _______________________

Country of Birth ________________________

Childs Name_____________________________________________________________________________
As it appears on passport (Family/Surname/Last) (Given/First) (Middle Name)

Male Female

Date of Birth (Day)_______ (Month)_______ (Year)_______ If you currently hold a valid U.S. visa in your passport, indicate type: Country of Citizenship _______________________

Country of Birth ________________________

Childs Name_____________________________________________________________________________
As it appears on passport (Family/Surname/Last) (Given/First) (Middle Name)

Male Female

Date of Birth (Day)_______ (Month)_______ (Year)_______ If you currently hold a valid U.S. visa in your passport, indicate type: Country of Citizenship _______________________

Country of Birth ________________________

Note: If an applicant plans on bringing dependents (spouse/children) to the United States, the applicant must add an additional $8,000 per family member over and above the minimum financial support amount. For example, an applicant who wishes to bring a spouse and one child must indicate a level of support of $40,000 ($16,000 + $24,000) when seeking admissions to the masters degree programs. An applicant seeking admissions to the bachelors degree programs who wishes to bring a spouse and one child must indicate a level of support of $49,080 ($16,000 + $33,080). F-2 visa dependents may not engage in full course study in the United States.

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