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Language and Culture Immersion Camp (LCIC)

Given (First) Name*
Family (Last) Name*
Date of birth:*
Country of Birth*
Country of Citizenship*
Gender:* Male    Female   
Street Address:*
City: *
Postal Code:*
Telephone Number:*
Fax Number:*
Email address:*
Visa Information:* I am coming to UCM with a Visitor Visa.
I want to apply for an F-1 Visa.
I am in the US now.* Yes    No   
I have an _____ visa. F-1    B-1    J-1    Other   
I hereby give permission for my records to be made available to the appropriate individuals and departments.* Yes    No