TRANSFER-IN F-1 INTERNATIONAL STUDENT ADMISSIONS APPLICATION
Camden County College
International Student Services Office - Taft Hall - 3rd Floor - Room: 312
200 College Drive, Blackwood, NJ 08012
Phone: 856-227-7200, ext. 4568 Email: ISSOffice@[Link]
THE SEVIS School Code: NEW214F10642000
Student Information
Term for which you are seeking admission: Fall ____________ Spring ___________ Year: ____________________
Degree or Program you wish to pursue at CCC: Program Code: _____________ Program Name: ______________________________
(Only AA., AS., or AAS., Degrees)
Name: ___________________________________________________________________________________________________________________________________
Family (Surname) First (Given) Middle
Current U.S. Address: _________________________________________________________________________________________________________________
Number and Street Apt#
____________________________________________________________________________________________________________________________________________
City State Zip Code
Telephone #: ___________________________________________ Valid Email: _______________________________________________________________
Date of Birth: __________ / _________ /_________ Gender: Male _____ Female _____ Marital Status: Single _____ Married ______
Month Day Year
Country of Birth: _______________________ Country of Citizenship: ________________________ City of Birth: ________________________
Passport #: ___________________________ Admission or I-94 #: ___________________________ SEVIS ID#: _______________________________
Are you currently in Lawful F-1 Student Status? Yes ___ No___ Are you pursuing a full course of study? Yes ___ No ___
Dates of Attendance at Current Institution: From: __________ / __________ /___________ To: __________ / __________ /__________
Month Day Year Month Day Year
Did or will you graduate from High School? _____Yes ______No Date of Graduation: _________ / _________ / _________
Month Day Year
____________________________________________________________________________________________________________________________________________
Name of Last High School Attended City / State / Country Start Date of High School: Month / Day / Year
Emergency Contact Person who resides in the U.S.: ________________________________ Emergency Phone#: _________________
Background Information
Ethnicity: (Check one) ________ Hispanic/Latino ________ Non-Hispanic/Non-Latino
Race: (Check all that apply) ________ American Indian/Alaska Native ________ Hawaiian/Other Pacific Islander
________ Asian ________ White ________ Black/ African American
Certification: I certify that the above answers are true, correct and complete to the best of my knowledge. If any statement is not true, I
understand I will be held responsible. Further, I agree to abide by the rules and regulations of Camden County College as outlined in the
College Catalog, the Students Handbook and my obligations I have to fulfill as a F1 International Student by adhering to USCIS rules and
regulations
Signature of Student: __________________________________________________________ Date: ______________________________________________
Policy on Non-Discrimination in Educational Programs: Camden County College complies with title VII of the Civil rights Act of 1964, Title IX of the Educational Amendments of
1972, Section 504 of the Rehabilitation Act of 1973, the Older Americans Act of 1975 and New Jersey’s Law Against Discrimination. These laws prohibit discrimination on the
basis of race, creed, color, national origin, nationality, ancestry, age, marital status, affectional or sexual orientation, sex, familial status, domestic partnership status, disability and
handicap. Decisions on admission, recruitment, financial aid programs, access to course offerings, or other aspects of its educational programs or activities, including vocational
programs and vocational opportunities, are not made on the basis of any of these factors. Inquiries regarding these laws may be directed to the General Counsel, Roosevelt Hall,
Room 104, Camden County College, P.O. Box 200, Blackwood, NJ 08012, (856) 227-7200, extension 4406 or to the Secretary, Department of Education, Washington, D.C. 20201.
