Request International Student Information

We welcome your requests for more information. Please complete and submit the following information.

Your contact information

First Name		(Alt+a)
Last Name		(Alt+b)
Address 1		(Alt+c)
Address 2		(Alt+d)
Suite/Apartment		(Alt+e)
City		(Alt+f)
State		(Alt+g)
Country		(Alt+h)
Postal Code		(Alt+i)
E-mail		(Alt+j)
Telephone		(Alt+k)
Fax		(Alt+l)

Your personal information

Nationality		(Alt+m)
Language		(Alt+n)
Date of Birth	(select month) January February March April May June July August September October November December	(Alt+o)
	(select date) 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31	(Alt+p)
		(Alt+q)
Would you bring dependents?	(select) Yes No	(Alt+r)
Funds available for study		(Alt+s)
English language ability	(select) Beginner Intermediate Advanced	(Alt+t)
TOEFL score (not required)		(Alt+u)
Date taken		(Alt+v)

You would begin school

Term	(select term) Fall (September) Winter (January) Spring (March/April) Summer (June)	(Alt+w)
Year	(select year) 2007 2008 2009 2010	(Alt+x)

After submitting, please approve transmission of this form via e-mail. Thank you.

(Alt+y)

Contact International Programs

Laju Nankani, Director
Centralia College
600 Centralia College Blvd.
Centralia WA 98531-4099 USA
E-mail: intl@centralia.edu
Phone: (360) 736-9391, ext. 492
Fax: (360) 330-7503