2019-2020 Student Application Personal Information Name of applicant as indicated on passport if passport is already issued. Please type or print. ______________________________ _________________________ ________________________________ SURNAME/FAMILY NAME First/Given Name Middle Name(s) (write in all capital letters) Home Address: Home Phone: Street and number: Mobile Phone: E-mail: City: State/province: Location where you currently live: Postal code: Federal Capital Major City Country: Other City/Tow Area Gender: Marital status: Do you have a Date of (month/day/year): Male Single passport? Month of birth: Female Married Yes Day of birth: Nonconforming No Year of birth: Country/Countries of citizenship: Place of birth (city or town and country, as listed in passport, if available): City of birth: Country: Country/Countries of permanent residence: Are you currently a student? Yes No What is the highest educational degree you have If yes, what is the course of study you are pursuing? completed? Please list the degree and the number of years of postsecondary of study. Yes No Are you enrolled in a degree program? Please list the name of the degree: How many years toward the degree have you completed? Name of college/institution where you are enrolled: Date you anticipate completing your degree: Have you participated in any U.S. government exchange program? Yes No If yes, give name of the program: Duration of the program : Year you participated: Your proposed Field of Study during the Community College Initiative Program: Applicants must apply in only 1 field of study. Select your preferred field of study from the options below. Then, select 2 or 3 concentration areas in that same field of study and note the order of your preference. Field of Study Concentration Area Rank Order Preference (check 1): (check 2 or 3): (1 is highest, 3 is lowest) Agriculture Agribusiness 1 2 3 Agricultural Geospatial Technology 1 2 3 Agricultural Production Management 1 2 3
Student Application 2019-2020 Personal Information Name of applicant as indicated on passport if passport is already issued. Please type or print. ______________________________ _________________________ ________________________________ SURNAME/FAMILY NAME First/Given Name Middle Name(s) (write in all capital letters) Home Address: Street and number: City: State/province: Postal code: Country: Home Phone: Mobile Phone: E-mail: Location where you currently live: Federal Capital Other City/Tow Major City Area Gender: Male Female Nonconforming Marital status: Single Married Do you have a passport? Yes No Date of (month/day/year): Month of birth: Day of birth: Year of birth: Country/Countries of citizenship: Country/Countries of permanent residence: Place of birth (city or town and country, as listed in passport, if available): City of birth: Country: Are you currently a student? Yes No If yes, what is the course of study you are pursuing? Are you enrolled in a degree program? Yes No Please list the name of the degree: How many years toward the degree have you completed? Name of college/institution where you are enrolled: Date you anticipate completing your degree: What is the highest educational degree you have completed? Please list the degree and the number of years of postsecondary of study. Have you participated in any U.S. government exchange program? Yes No If yes, give name of the program: Duration of the program : Year you participated: Your proposed Field of Study during the Community College Initiative Program: Applicants must apply in only 1 field of study. Select your preferred field of study from the options below. Then, select 2 or 3 concentration areas in that same field of study and note the order of your preference. Field of Study (check 1): Concentration Area (check 2 or 3): Rank Order Preference (1 is highest, 3 is lowest) Agriculture Agribusiness 1 2 3 Agricultural Geospatial Technology 1 2 3 Agricultural Production Management 1 2 3