* Required fields

Your First Name: *

Your Last Name: *

Your MHC Email:*
NOTE: If you don't yet have your MHC email,
type your last name and then @mtholyoke.edu

Country of Citizenship: * 

Country of Residence
(the country in which you/your parents permanently reside and pay taxes, if applicable):

Date of Birth: (date: mm/dd/yyyy) *

Country of Birth: *

City of Birth: *

Current Address: *

Current Telephone: *

Current Fax:

Current Email: *

Current address valid until: (date: mm/dd/yyyy) *

Permanent Address: *

Permanent Telephone: *

Permanent Fax:

Permanent Email: *

Passport Information:

Issued by (country): *

Expiration Date: *

If you are Currently in the US:

What is your SEVIS ID number:

Current visa status (from I-94):

• If you are or have been attending high school or college in the US, you must ask your
  current or most recent adviser to complete the Foreign Student Adviser's Report for
  Students Currently in the US.

Do you plan to travel outside of the US prior to your arrival at Mount Holyoke?
Yes No

If yes, please indicate the approximate dates you plan to travel:

Will you be traveling to your home country during this time?
Yes No

If you are Currently Outside of the US:

Have you entered or studied in the US as an:

F-1 student Yes No

J-1 Exchange-Visitor Yes No

If yes, please list the dates involved and where you studied:

Approximate date of your planned departure to travel to the US:
(date: mm/dd/yyyy)