Lake Land College

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International Student Intent to Enroll - Lake Land College
 
 

International Student Intent to Enroll

 


Step 1: Personal/Visa Info
 
 
Section 1: Personal Information
 
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Family Name:
Given Name:
Sex: Male Female
Marital Status: Single Married
Date of Birth:
Country of Birth:
Country of Citizenship:
Native Language:
   
Permanent home address:
Address:
City: Postal Code:
Country:
Telephone: (country code/city code/number)
Email:
I expect to come to the United States:
Alone  
With Spouse  
  Name:
  Date of Birth:
  Country of Birth:
 
With Child  
  Name:
  Date of Birth:
  Country of Birth:
 
  Name:
  Date of Birth:
  Country of Birth:
 
  Name:
  Date of Birth:

 

Country of Birth:
 
Please list those individuals who will be responsible for your expenses while at Lake Land.  This includes tuition, housing, meals, insurance, etc.
  Name:
  Relationship to you:
  Address:
  Phone:
  Email:
 

Section 2: Visa Information
 
Type of Visa Currently Held (if any):
If "other", please explain:
 
 
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5001 Lake Land Blvd.
Mattoon, IL 61938-9366
217-234-LAKE
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