Application

International Student Application Form

First Name

Middle Name

Last Name

Phone

Gender

Male

Female

Date of Birth

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Country of Citizenship

Have you ever been convicted of a felony crime?

Yes

If yes, please explain:

Emergency Contact Information

First Name

Last Name

Relationship to Applicant

Home Phone

Mobile Phone

Emergency Contact Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Family Information – Father

Is your Father Living?

Yes

If no, Provide Date of Death

Father First Name

Father Last Name

Occupation

Date Worked From

Employer

Still Employed?

Yes

Father Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Highest Level of Education Completed

Family Information – Mother

Is your Mother Living?

Yes

If no, Provide Date of Death

Mother First Name

Mother Last Name

Occupation

Date Worked From

Employer

Still Employed?

Yes

Mother Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Highest Level of Education Completed

Background Information:

List all high schools, colleges, and universities you have attended for any length of time, whether or not you have completed a term.

High School Name

Date From

Date To

High School Address*

Address Line 1

Address Line 2

City

State

Zip Code

Country

Class Rank (Example 97/100)

University Attended (If any)

Date From

Date To

Please attach a year by year transcript for EVERY school year completed. Please attach an official letter of recommendation from the last school or institution attended

Choose File

Work Experience:

Name of Company or Workplace

Employers First Name

Employers Last Name

Job Title or Description

Address of Workplace

Employed From:

Still Employed?

Yes

Please attach a letter of recomendation if applicable

Choose File

Extracurricular Activities:

Community Service – List and describe briefly all the community service that u have been enrolled in or have been practicing for the past 3 years:

Please attach a letter of recommendation of any community service institution you have attended If Applicable

Choose File

Hobbies – List all the hobbies you have and explain briefly about each one. (time spent practicing the hobby, level of skill in it, … etc.)

Declaration:

I certify that all statements on this application are correct and
complete, including my declaration of citizenship and status in America. I authorize the
L.O.V.E. AMERICA FOUNDATION to verify any information or documentation provided as part
of this application and to request directly from other sources any relevant
documentation/information that pertains to the review process. I understand that the
selection committee’s decision is final and that I will abide by that decision.

Name

Date / Time