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US STUDENTS APPLICATION
INTERNATIONAL STUDENTS
....STUDENT APPLICATION
....APPLICATION I20

California School of Dental Assisting
1506 Huntington Drive
South Pasadena, California 91030
(626) 799-3777
(626) 799-3208 fax
www.CaliforniaSchoolOfDentalAssisting.com
Student Name
First Name
Country of Birth
Date of Birth
Country of Citizenship
Foreign Address
Foreign Address 2
City
Province/ Territory
Postal Code
Country
US address
US address 2
City
State
Zip
Gender (F,M)
Driver License Number
Driver License Issue State
Social Security Number
Individual Taxpayer ID Number

Admission Number
(To be provided by school)

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