INTERNATIONAL PROGRAMS

ITL197 Registration Form

Personal Information

First Name

Last / Family Name

Date of Birth

Gender

Female Male

Social Security Number

Note: Your SSN is confidential and, per the Family Educational Rights & Privacy Act, is protected from unauthorized use and/or disclosure.

Ethnicity / Race

Please specify what other race:

Country of Citizenship

Contact Details

Phone Number

Mailing Address

Street Address

City

State/Province

Postal Code

Country

Academic Background

Have you already graduated from high school or completed secondary education?

Yes No
Note: GED certfication, as well as IB, IGCSE, and O-Level diplomas with completion of at least 5 subjects are considered equivalent to high school graduation.

Name and location (city, state, country) of the last high school you attended:

What level of education have you completed beyond high school / secondary education?

Name and location (city, state, country) of the last college / university you attended:

What school grade are you currently in / did you last complete?

When will you graduate?

Is English your second language?

Yes No

Study Plans

When would you like to start your ITL197 class?

Do you plan to continue studying at Seattle Central College after completing this class?

Yes No I do not know at this time

How long do you plan to attend Seattle Central College?

What is your intended major?

What is your main long-term study goal?

Please specify:

Are you / Will you be taking part in a high school exchange, internship, or volunteer experience abroad?

Yes No

Please specify your plans and the name of the agency you used to sign up for this program abroad: