International Applicant Supplement

1. Student Last Name (surname/family name) ________________________________

Yai

2. Student First Name________________________________

Dhum

3. Student Middle Name________________________________

Ayoub

4. Student Date of Birth________________________________

9/6/2009

5. Student Country of Birth Egypt

________________________________

6. Student Country(ies) of Citizenship________________________________

South Sudan

7. Does the student currently hold a valid I-20 (Yes/No) ________________

No

8. If Yes, from what school?________________________________

9. Student current grade ________________________________

8

10. Student is applying for grade________________________________

9

11. Student email address________________________________

dhumdeng@gmail.com

12. Does your family employ anyone in the home or family business? (Yes/No) No
___________

13. If Yes how many are in home and/or business? ________________________________

 International Applicant Supplement

14. Does your family have any assets, cash, or property held in a country other than the

United States? (Yes/No) ____________

No

15. If yes, please indicate the country(ies) and amount(s)

________________________________________________________________

________________________________________________________________

________________________________________________________________

I hereby acknowledge that all of the information provided in this document is true, accurate,
and complete to the best of my knowledge. I understand that providing false information may
jeopardize a student’s visa or financial aid eligibility and/or status.

Signature of Parent/Guardian 1 ____________________________________

Jackline Deng

Date_____________
1/14/2023

Signature of Parent/Guardian 2 ____________________________________

Date_____________