Esli-Requisitos y Universidades

USA
Eastern University McNeese State University New Mexico Tech Texas A&M University Corpus Christi University of Southern Indiana West Texas A&M University Western Kentucky University Bowling Green Community College at Western Kentucky University
CANADA
Trinity Western University Langley, British Columbia
4528 Humphrey Hill Road Sedro Woolley, WA 98284 Email: esli@esli-intl.com Website: www.esli-intl.com
TEL: 360-724-0547 FAX: 360-724-0548
ESLI Costs and Dates Trinity Western University Langley Campus
Eastern University McNeese State University Morehead State University Texas A&M University Corpus Christi University of Southern Indiana West Texas A&M University Western Kentucky University EXIT
ESLI Course Fees & Calendar Fall 2010-Summer 2011

4528 Humphrey Hill Road Sedro Woolley, WA 98284 Printable Fees and Calendar Tel: 360-724-0547 Fax: 360-724-0548 Email: ESLI@ESLI-intl.com Effective July 1, 2010
TRINITY WESTERN UNIVERSITY

Application Fee Courier Fee (per I-20 mailing) One time costs before student arrives: Homestay Placment Fee Dormitory Deposit Airport Pickup Service Semester Costs ESLI Tuition TWU University Fee Health Insurance (temporary) BC Health Insurance ($57 month) Security Deposit Housing Options Homestay Rent Homestay Transportation Telephone Deposit TWU Dormitory Room & Meals
C$
100 40 225 200 90 15 weeks 4,800 1,665 148 228 100 2,680 440 100 4,350 SUMMARY Tuition, Fees, Dormitory & Meals 15 Weeks C$10,815
Fall 2010 Start of Term Last Date to Register End of Term Spring 2011 Start of Term Last Date to Register End of Term
9/7/2010 10/4/2010 12/17/2010
Tuition, Fees & Homestay 15 Weeks C$9,585
Students are allowed to arrive within the first 6 weeks of the term and join program already in progress. Summer 2011 Start of Term Prices will be prorated Last Date to Register Contact ESLI office for prorated End of Term invoice for late arriving students
1/10/2011 2/11/2011 4/22/2011
5/2/2011 6/3/2011 8/12/2011
EASTERN UNIVERSITY
Application Fee Courier Fee (per I-20 mailing) One time costs before student arrives: Deposit - REQUIRED 3 weeks before start date Airport Pickup Service - Single Airport Pickup Service - Family ECE Transcript Evaluation Fee (Masters Level Only) Semester Costs ESLI Tuition EU Student Fees Health Insurance - Fall Health Insurance - Spring Health Insurance - Summer Dormitory Room (shared- basic) Books Meal Plan Options for Semester 20 meals per week
US$
100 40 2,000 75 100 210 15 Weeks 4,245 500 463 722 307 2,890 225 2,070 SUMMARY (Fall & Spring) Tuition, Fees & Dormitory 15 Weeks US$7,635 Fall 2010 Start of Term Last Date to Register End of Term Spring 2011 Start of Term Last Date to Register End of Term Summer 2011 Start of Term Last Date to Register End of Term
8/18/2010 10/1/2010 12/3/2010
SUMMARY (Summer 2011) Super-Intensive Program Tuition, Fees & Dormitory 10 Weeks US$6,945 Prices will be prorated Contact ESLI office for prorated invoice for late arriving students
1/18/2011 2/26/2011 4/29/2011
5/16/2011 6/6/2011 7/22/2011

MCNEESE STATE UNIVERSITY

Application Fee Courier Fee (per I-20 mailing) One time costs before student arrives: Dormitory Deposit Airport Pickup Service - Single Airport Pickup Service - Family ECE Transcript Evaluation Fee Semester Costs ESLI Tuition MSU Student Fees Health Insurance Dormitory Room (Apartment) Books Meal Plan Options for Semester Declining Balance
US$
100 40 325 50 75 210 15 weeks 4,245 569 195 2,325 225 1,141 SUMMARY (Fall & Spring) Tuition, Fees & Dormitory 15 Weeks US$7,139 Fall 2010 Start of Term Last Date to Register End of Term Spring 2011 Start of Term Last Date to Register End of Term Summer 2011 Start of Term Last Date to Register End of Term 8/30/2010 10/13/2010 12/17/2010
1/24/2011 3/4/2011 5/13/2011
6/6/2011 7/1/2011 8/12/2011
MOREHEAD STATE UNIVERSITY

Application Fee Courier Fee (per I-20 mailing) One time costs before student arrives: Dormitory Deposit Airport Pickup Service - Single Airport Pickup Service - Family WES transcript evaluation fee Semester Costs ESLI Tuition MSU Student Fees Health Insurance Dormitory Room (shared) Books Meal Plan Options for Semester 19 meals per week 15 meals per week 10 meals per week
US$
100 40 100 50 75 212 15 weeks 4,245 532 195 1,900 225 1,550 1,490 1,265 SUMMARY (Fall & Spring) Tuition, Fees & Dormitory 15 Weeks US$6,677 Fall 2010 Start of Term Last Date to Register End of Term Spring 2011 Start of Term Last Date to Register End of Term Summer 2011 Start of Term Last Date to Register End of Term 8/23/2010 9/3/2010 12/17/2010
1/17/2011 1/28/2011 5/13/2011
6/6/2011 6/16/2011 8/5/2011

TEXAS A&M UNIVERSITY-CORPUS CHRISTI

Application Fee Courier Fee (per I-20 mailing) One time costs before student arrives: Dormitory Deposit Airport Pickup Service - Single Airport Pickup Service - Family FCSA Evaluation Fee Semester Costs ESLI Tuition TAMUCC Student Fees Health Insurance Dormitory Room (shared) Books Meal Plan Options for Semester Declining Balance
US$
100 40 400 50 75 110 15 weeks 4,245 570 195 3,650 225 1,000 SUMMARY (Fall & Spring) Tuition, Fees & Dormitory 15 Weeks US$8,465 Fall 2010 Start of Term Last Date to Register End of Term Spring 2011 Start of Term Last Date to Register End of Term Summer 2011 Start of Term Last Date to Register End of Term 8/23/2010 10/4/2010 12/15/2010
1/10/2011 2/25/2011 5/6/2011
5/30/2011 6/24/2011 8/12/2011
UNIVERSITY OF SOUTHERN INDIANA

Application Fee Courier Fee (per I-20 mailing) One time costs before student arrives: Dormitory Deposit Airport Pickup Service - Single Airport Pickup Service - Family ECE Transcript Evaluation Fee Semester Costs ESLI Tuition USI Student Fees Health Insurance Dormitory Room (shared) Books Meal Plan Options for Semester Declining Balance - Blue Plan
US$
100 40 200 50 75 210 15 weeks 4,245 617 480 1,780 225 1,680 SUMMARY (Fall & Spring) Tuition, Fees & Dormitory 15 Weeks US$6,642 Fall 2010 Start of Term Last Date to Register End of Term Spring 2011 Start of Term Last Date to Register End of Term Summer 2011 Start of Term Last Date to Register End of Term
8/24/2010 10/4/2010 12/10/2010
1/5/2011 2/7/2011 4/29/2011
5/9/2011 5/31/2011 7/15/2011

WEST TEXAS A&M UNIVERSITY

Application Fee Courier Fee (per I-20 mailing) One time costs before student arrives: Dormitory Deposit Airport Pickup Service - Single Airport Pickup Service - Family Semester Costs ESLI Tuition WTAMU Student Fees Health Insurance Dormitory Room (shared) Books Meal Plan Options for Semester 13 meals per week 11 meals per week 75 meals per Semester
US$
100 40 100 50 75 15 weeks 4,245 874 274 1,550 225 1,563 1,478 658 SUMMARY (Fall & Spring) Tuition, Fees & Dormitory 15 Weeks US$6,669 Fall 2010 Start of Term Last Date to Register End of Term Spring 2011 Start of Term Last Date to Register End of Term Summer 2011 Start of Term Last Date to Register End of Term
8/30/2010 10/13/2010 12/10/2010
1/19/2011 3/9/2011 5/5/2011
6/1/2011 6/30/2011 8/11/2011
WESTERN KENTUCKY UNIVERSITY

Application Fee Courier Fee (per I-20 mailing) One time costs before student arrives: Dormitory Deposit Airport Pickup Service - Single Airport Pickup Family- each additional person Semester Costs ESLI Tuition WKU Student Fees Health Insurance Dormitory Room (shared) Books Meal Plan Options for Semester 19 meals per week 14 meals per week 10 meals per week
US$
100 40 150 90 35 15 weeks 4,245 420 497 1,865 225 1,320 1,200 1,040 SUMMARY (Fall & Spring) Tuition, Fees & Dormitory 15 Weeks US$6,530 Fall 2010 Start of Term Last Date to Register End of Term Spring 2011 Start of Term Last Date to Register End of Term Summer 2011 Start of Term Last Date to Register End of Term
8/23/2010 10/13/2010 12/17/2010
1/17/2011 3/4/2011 5/13/2011
6/6/2011 7/1/2011 8/12/2011
8/12/2011
These tables were prepared on the basis of the best information available at the time of printing, all information is subject to change pending approval by board of regents or legislation.
Trinity Western University

APPLICATION CHECKLIST
STUDENT NAME:______________________________
Academic English & University Entrance

UNDERGRADUATE & ENGLISH______ GRADUATE & ENGLISH_______ START DATE FOR ENGLISH____________ MAJOR AREA OF STUDY______________ This application package must include the following items: 1. A completed, signed Application for Admission 2. C$140 TWU Application & Courier Fees 3. Official certified school transcripts (originals required for MBA) 4. Original certified diploma or degree certificate 5. 2 letters of recommendation (required for MBA) 6. Statement of Purpose include academic & career goals (required for MBA)
ENGLISH ONLY
TWU/ESLI ONLY______ START DATE____________ ENDING DATE___________ This application package must include the following items: 1. A completed, signed International Student Application for Admission (2 pages) 2. C$140 TWU Application & Courier Fees
To arrange Housing: 1. Housing Application form 2. C$1,000 advance deposit must be received
AGENCY: ______________________________ COUNSELOR:___________________________ ADDRESS:______________________________ ________________________________________ CITY:______________COUNTRY:___________ TEL:_______________ FAX:________________ EMAIL:_________________________________
Mailing Address:
ESLI 4528 Humphrey Hill Road Sedro Woolley, Washington 98284 USA Tel: 360-724-0547 Fax: 360-724-0548 Email: esli@esli-intl.com Website: www.esli-intl.com
Trinity Western University

ESL, Undergraduate and Graduate Application
(for English as a Second Language Learners)
PLEASE PRINT CLEARLY Application Steps: 1 Application for Admission - Complete and sign the Application form 2 Transcripts - Official original transcripts from all schools attended are required for entrance to degree programs. 3 Application fee - A non-refundable fee of $140 CDN must be included with your application to TWU.
Personal Information
Name:
Family Given
Single
Married Date of Birth:

Day
Male
Month
Female
Year
Citizenship: _____________________________________
Address Information
Street: Province/State: Home Phone: Country: Fax: City: Postal Code: Email:
Education History
High School: College/University: College/University:
You must list all schooling in chronological order beginning with high school and ending with the present.
End Date: End Date: End Date:
Work History
Title:
Please provide information about any jobs you may have had. Use the back of this sheet if necessary.
Start date:
(Please check only ONE English program.)
End Date:
Program
Official transcripts from ALL schools listed above are required for entrance into degree programs.
Academic English for TWU Undergraduate Entrance Major: Redeemer Pacific College Academic English Only
School of Graduate Studies (SGS) iMBA GMAT score __________ (if taken) Biblical Studies Pre-Masters English Program (PMP) Intended Area of Study:
(for students not applying to TWU Graduate programs)
Enrolment dates
Spring (Jan - April) Start Date: Summer (May - Aug) Fall (Sept - Dec) End Date: in the year
Residence Request
Dorm Homestay Other (if 21 years of age or older) Living with parents
How did you first hear about TWU / ESLI? I have read and agree to the Responsibilities of Membership (student signature) NOTE: Application is NOT complete and will NOT be processed if application fee is not included and any portions of this form are left blank. TWU/ESLI USE ONLY AG CS MO TR
Initials
ESL Processing provided by: English as a Second Language International 4528 Humphrey Hill Road, Sedro Woolley, WA 98284 Tel: 360-724-0547 Fax: 360-724-0548 www: esli-intl.com e-mail: esli@esli-intl.com
Page 2
Responsibilities of Membership in the Community of T.W.U.
Trinity Western is a Christian university, subject to its overall mission and purpose. Admission is open to any qualified person regardless of race, colour, nationality, or creed. The University seeks to maintain a campus atmosphere which it believes to be consistent with its profession of Christian Faith, one that is conducive to growth and development. Trinity Western is primarily a residential university, providing many opportunities for growth outside the classroom. The University believes this growth needs to be guided by the mutual respect and concern of individual community members for one another. As a Christian community, Trinity Western is committed to an integration of biblical Christianity with the liberal arts and sciences, an integration relevant to ones personal life, to classroom disciplines, to co-curricular activities, and to societal experience in general. Therefore, the purposes of Trinity Western as stated below are designed to encompass the total life of those persons who have committed themselves to this unique institution, and to promote scholarly study which explores the liberal arts in an historic Christian perspective. The University is committed to: Provide students with a broad beginning in liberal arts education, introducing them to the major organized fields of human knowledge, and thereby developing a foundation for further study. Train students in the skillful use of the tools of language and thought: the development of other skills including those of social relationships - the qualities of poise, tolerance and co-operativeness. Assist students in achieving direction and decision in choice of a vocation or profession, and in preparation for participation in their communities as well-informed Christian citizens. Provide for students a wholesome Christian character, strengthening faith in God and in Jesus Christ as Saviour and Lord. Promote confidence in the Bible as the standard for faith and practice: encourage students in their formulation of a world and life-view that is related to, and integrated with, natural and biblical revelation. Encourage students to be actively involved in a local church of their choice.
Students, whether on or off campus, are responsible to: Refrain from practices which are biblically condemned. These include: drunkenness; swearing, or use of profane language; all forms of dishonest practices including: cheating and stealing; abortion; involvement in the occult; and sexual sins including :premarital sex; adultery; and homosexual behaviour. Uphold behavioural standards which exist as positive applications of biblical principles and for the betterment of the whole community. These require a member of the Trinity Western community to abstain from the use or possession of: alcoholic beverages, gambling, tobacco in any form, marijuana, and drugs for non-medical purposes, social dancing, and to maintain discreet, inoffensive behaviour in relationships with the opposite sex. Exercise careful judgment in the use of time, energy and material resources, the choice of entertainment including television, movies, and live productions. Engage in the honest pursuit of knowledge including: regular attendance at classes, chapel services and university events. Respect the property of others and to behave in a manner which reflects a concern for others safety and well-being.
Community standards designed to promote such an atmosphere have been kept to a minimum in the belief that growth to maturity is best fostered as individuals themselves come to see the patterns that lead to meaningful growth. The University does, however, believe that achievement of the ideals mentioned require adherence to certain minimal expectations in lifestyle by all students expectations that have come to be accepted as desirable standards of conduct by most Christian communities. While it is recognized that some may not have personal convictions wholly in accord with these responsibilities and standards, the purpose and ideals underlying them necessitate students willingness to modify their own personal preferences and standards of conduct while under the jurisdiction of the University, with the full understanding that this is in the best interests of this academic community they have chosen to join. Students who cannot with integrity support these standards should seek a living-learning situation more acceptable to them. In applying for admission and subsequently enrolling, I agree to accept the responsibilities of membership in the community of Trinity Western, which includes adherence to the specific standards of conduct stated above. I hereby make application for admission to Trinity Western University and enclose my $135.00 application fee. I understand that this fee is not refundable but will be credited to my account if I am accepted to and actually attend Trinity Western. I am aware that all single students under the age of 21 are required to live on campus or in an approved homestay unless living with parents. If admitted I agree to abide by these Community Standards and the rules and regulations of the University. Date: _______________ Signature: ______________________________
Name: (please print) ____________________________________________

ESLI APPLICATIONS: FORM 001B
Affiliated With
Homestay Application
TWU ID #: Student's Personal Information: Family Name: Address: __________________________ ESLI ID#:
First and Middle: __________________________ Sex: ____ Male _____ Female
___________________________________________ ___________________________________________
City: Country: Telephone: Email Address: Country of Citizenship:
_________________________ __________________________ __________________________ ___________________________
State/Province: __________________________ Postal Code: __________________________ Fax: __________________________ Birthdate: ___________________________ (MM/DD/YYYY) Country of Birth: ___________________________
__________________________
Emergency Contact Information: Contact Name: ___________________________ Relationship: ___________________________ Tel No (Evening): ___________________________
Tel No (daytime): ___________________________
Information about You: What kind of hobbies or activities do you enjoy? _______________________________________________ _________________________________________________________________________________________ Please select as many characteristics that apply to you: _____ Cheerful _____ Serious _____ Talkative _____ Tidy _____ _____ Quiet _____ Shy Optimistic _____ Outgoing
_____ Independent _____ Talkative
Have you ever had a job? _____ Yes _____ No If yes, what kind of job ______________________________________________________________________ Do you prefer to take Public Transit (bus) or have the family drive you to school? ______ Bus ______ Drive Do you have your own car? _____ Yes _____ No
Do you prefer: a homestay with _____ young children _____ older children _____ no children _____ Single Mom _____ Single Adult Would you like to have another ESL student in the same home? _____ yes _____ no _____ doesn't matter
Have you been in a homestay program before: _____ Yes _____ No If yes, for how long? ___________________________ Where? _______________________________
How long do you wish to live with a homestay family in Canada? _________________ When will you move into homestay? ________________________________________ Why did you choose to study at ESLI? ______________________________________________________ In your opinion, what should a homestay do for you to make your stay in their home enjoyable? ________________________________________________________________________________________ Do you like to spend a lot of time at home? _____ Yes _____ No _____ Sometimes Health: Are there any foods that you cannot eat? List them: _____________________________________________ List medical restrictions: ____________________________________________________________________ Do you have any allergies: Specify: ____________________________________________________________ Do you require special medical treatment? Specify: ______________________________________________ Do you smoke? _____ Yes _____ No
Religion: What is your religious preference: ________________________________________ Have you ever been to a Christian church? _____ Yes _____ No Schooling: Did you graduate from high school? _____ Yes _____ No Have you been studying at university? _____ Yes _____ No Level of written English: _____ Beginner _____ Intermediate _____ Advanced Level of spoken English: _____ Beginner _____ Intermediate _____ Advanced What is your profession or area of study? ______________________________________________________
ESLI will strive to find a homestay that will meet as many of your preferences as possible.
_______________________________________ Signature:
_______________________________________ Date of Application:
Accepted Student Information Card

1 Photo ID Card
Student ID cards will be prepared before you arrive. Your photo ID card allows you access to many services, including the Alloway Library and Food Services. Please send two color passport size photos of yourself. Attach both photos to this form. Please write your name and I.D. number on the back of each photo.
Attach Photo #1 Here Please ensure picture is in one month before classes in order for your ID card to be ready upon your arrival.
Attach Photo #2 Here Please write your city, state/province, name and ID number on the back of this photo.
Name: ID# I will:
Miss Mrs. Ms. Mr.
Enrolling: live in residence
Fall
Spring
commute
2 Student Information
I will be a: University Housing Resident (Fill out A) Commuter (Fill out B)
For Office Use Only:
Tel: ( Year entering: 1
) 2 3 yes 4 no New student Re-enrolling student Returning Student
Name: Address: City: Prov./State: Country: Postal/Zip Code:
Transfer student?: E-mail: Sex: male
female Student ID#:
TWU Mailbox #
Birth date (mm/dd/yy):
SECTION (A) Housing Application

Section for on-campus residence
I require university housing for: fall semester spring semester
As responsible members for the TWU residence community, students are reminded that Trinity Western University does not provide personal insurance for, nor take liability directly or indirectly for personal student property. Students are encouraged to obtain personal insurance coverage for themselves and their possessions. I have read, understand, and accept the above conditions.
yes no
I am an international student from (country): I am an ESLI student from (country): Roommate request (must be mutual): Building preference: Intended major/area of study: Hobbies/interests: I am interested in rooming with an International student:
I need a quiet and orderly environment in which to study I study best late at night I enjoy getting to know people from different backgrounds I tend to be neat and orderly with my room I prefer to keep my room very quiet and private I tend to sleep late in the morning never never never never never never
Your responses will be used to select a compatible roommate

rarely rarely rarely rarely rarely rarely occasionally occasionally occasionally occasionally occasionally occasionally often often often often often often always always always always always always
_________________________________ Student Signature _________________________________ Date Signed
Note: The residence application will not be processed without the deposit. Mail this registration and $1000 deposit to the ESL Administration office.
FOR OFFICE USE ONLY:

Date payment received:
Date Housing application received:

US / CDN Initial:
Chq # Date deposited to ES: Initial:
Amount: $
SECTION (B) Commuter

Name:______________________________________________ Student ID:_________________________________________ I will commute for: I will study: Fall full time Spring part time I would like the Tip-off (weekly announcement bulletin) yes no e-mailed to me: I commute by: foot car carpool bus bike
I commute to TWU: 1-5km 5-10km
11-20 km
20-30 km yes
more than 30 km no 31 or more
Assuming your studying adds up to 100 per cent, what percentage of time will you study at home?___________ On campus?___________ Have you applied for your Collegium Membership? yes no yes no Do you plan to?
I am interested in car pooling:
Hours per week I expect to work while attending TWU: 0 1 - 10 11 - 20 21 - 30 I have a church I attend regularly yes no
Note: Please send in your $1000 deposit to the ESL Administration office.
USA
Eastern University McNeese State University Morehead State University Texas A&M University Corpus Christi University of Southern Indiana West Texas A&M University Western Kentucky University Bowling Green Community College at Western Kentucky University
CANADA
TEL: 360-724-0547 FAX: 360-724-0548
ESLI CREDIT CARD AUTHORIZATION

NAME OF STUDENT: __________________________________________________
I authorize ESLI to debit on my credit card details as follow:
CREDIT CARD HOLDER:__________________________________________ ( ) MASTERCARD ( ) VISA ( ) AMERICAN EXPRESS
CREDIT CARD NUMBER:__________________________________________ SECURITY CODE (3 digits):________________ EXPIRATION DATE:________________ ZIP CODE: ______________
The amount of $___________ That refers to the payment of the enrollment fee at the ESLI Language Center.
__________________________ Credit Card Holders Signature __________________________ City, and Date
Eastern University
STUDENT NAME:______________________________

UNDERGRADUATE & ENGLISH______ GRADUATE & ENGLISH______ START DATE FOR ENGLISH____________ MAJOR AREA OF STUDY______________ This application package must include the following items: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10 11 Application for Admission Form US$140 application & Courier fees payable to ESLI Official Original Certified original school transcripts Official Original Certified School graduation diploma Sponsors Financial Guarantee form, signed by sponsor Original Sponsors Bank letter showing balance available 2 letters of recommendation teacher/counselor & work reference or pastor Essay Question as noted in Section 4 of application Resume Study Plan ECE Application form and $210 fee for Official Detailed Evaluation of Coursework for ALL Masters level applicants & Bachelor level applicants with prior college or university credits. Copy of students passport Health Form On Campus Housing Application
12 13 14
Mailing Address:
ESLI 4528 Humphrey Hill Road Sedro Woolley, WA 98284 USA Tel: 360-724-0547 Fax: 360-724-0548 Email: esli@esli-intl.com
Eastern University
International Application for Admissions
SECTION 1 OF 5: INFORMATION I AM APPLYING FOR: [] August 20____ [] January 20____ ENTERING STATUS: I INTEND TO: [] First-Year Student [] Live on Campus [] Commute to Campus [] Transfer Student
[] ESLI and Undergraduate Degree Program [] ESLI and Graduate Degree Program Intended Major area of study: __________________________________ FULL NAME: __________________________________________________________________________ Last (Family) First Middle Maiden Other name(s) which might appear on previous academic records _________________________________ Home Address _________________________________________________________________________ (in home country ) Street and number City State/Province __________________________________________ Postal code Country ____________________________________ Telephone (with country code)
Current Mailing Address (if different) -______________________________________________________ ______________________________________________________________________________________ Email_______________________________ How did you learn about Eastern University?______________ Date of Birth ________________ Gender: [] Male [] Female Month/Day/Year Relationship ______________ Marital Status: [] Single [] Married
Parents/Guardian who could be notified in case of an emergency: _________________________ Address (if different from home address above) ___________________ _____________________________________________________________ Telephone ________________ How would you describe yourself? (Please check one.) *Your response to this question is voluntary and will not be used in making an admission decision. This information is needed by the University and the government for statistical purposes. [] Asian/Pacific Islander [] Hispanic [] White/Non-Hispanic [] Black [] American Indian/Alaskan Native [] Non-Resident Alien Country of Birth________________________ Country of Citizenship______________________ If not a U.S. Citizen, Do you have Resident status? [] No [] Yes Alien Registration number___________ If student currently in U.S.A. Date of Entry__________ Type of visa at entry_________ Date I-20 expires______________________
What institution issued the I-20 for your current visa? ______________________________________________ Are you currently enrolled in the institution? [] Yes [] No
*Please send copies of any immigration / I-94 and related documents with your application
SECTION 2 OF 5: EDUCATION INFORMATION List in chronological order each school or institution you have attended, begin with secondary school and end with the present. Include each school or institution attended, the dates attended and the degree received. If you need additional space, use a separate page.
Name of School or Institution and Location Type of School: Secondary, College, University, Etc. Attended From To (MM/Year MM/Year) Actual Name of Diploma, Degree or Certificate Date Received
Have you ever withdrawn or been dismissed from an academic institution [] Yes [] No If yes please explain on a separate page Have you taken the ACT / SAT? [] Yes [] No SAT scores: Verbal_______ ACT score:__________ Have you taken the (TOEFL) Were your scores sent to Eastern University? [] Yes [] No Test Date______
Math_________ Total______ Test Date__________ [] Yes [] No
TOEFL score__________
SECTION 3 OF 5: ADDITIONAL INFORMATION Have you ever been convicted of a crime in the United States or any other country? [] Yes [] No If yes please explain_______________________________________________________________________________________ SECTION 4 OF 5 ESSAY QUESTION If you would like to tell us more about yourself, please complete the following question on a separate sheet of paper and attach when submitting application (maximum 1 page) Describe an accomplishment in your life. What did it take for you to succeed? What did you learn about yourself from this experience? SECTION 5 OF 5 SIGNATURE STATEMENT Please read Easterns Doctrinal Statement and Standards of Conduct (attached). DO YOU AGREE TO COMPLY WITH EASTERNS STANDARDS OF CONDUCT AS LISTED? [] Yes [] No I certify that the information which I have herein provided is true to the best of my knowledge and realize that any falsification of information may release the University from considering my application for admission or may lead to dismissal from the University at a later date. SIGNATURE___________________________________________________ DATE________________________ Return all admissions materials to Eastern University ESLI 4528 Humphrey Hill Road Sedro Woolley, WA 98284 USA Fax: 360-724-0548 Tel: 360-724-0547
D O C T R I N A L S TAT E M E N T
Eastern is committed to an evangelical and theologically conservative position and is dedicated to the Lord Jesus Christ. Therefore, it is the rule for members of the faculty, administration, and Board of Trustees to subscribe annually to the doctrinal statement of Eastern University which reads:
SECTION I
of the believerdeath to sin and resurrection to newness of life; and the Lord's Supper is a commemoration of the Lord's death until He comes. We believe that a New Testament church is a body of believers thus baptized, associated for worship, service, the spread of the Gospel, and the establishing of the Kingdom in all the world.
SECTION II
We believe that the Bible, composed of the Old and New Testaments, is inspired of God and is of supreme and final authority in faith and life. We believe in the supernatural as the vital element in the revelation and operation of the Christian faith. We believe in one God eternally existing in three PersonsFather, Son, and Holy Spirit. We believe that Jesus Christ was begotten of the Holy Spirit and born of the Virgin Mary, and that He is true God and true man and is the only and sufficient Mediator between God and humankind. We believe in the personality of the Holy Spirit and that His ministry is to reveal Christ to humankind in the regeneration and sanctification of their souls. We believe that man and woman were created in the image of God, and that they sinned and thereby incurred spiritual death. We believe in the vicarious death of the Lord Jesus Christ for our sins, in the resurrection of His body and His ascension into Heaven, His personal and visible future return to the earth and that salvation is received only through personal faith in Him. We believe that baptism is immersion of a believer in water, in the name of the Father and of the Son, and of the Holy Spirit; setting forth the essential facts in redemptionthe death and resurrection of Christ; also essential facts in the experience
Every member of the Board of Trustees, every administrative officer of the institution, professor, teacher, and instructor shall annually subscribe over his or her signature to the foregoing Doctrinal Basis, excepting only that a non-Baptist individual occupying any of the foregoing positions shall not be required to subscribe to that part of the Doctrinal Statement regarding the mode of water baptism and to the definition of the New Testament church, as stated in subparagraph J of Section 1.
SECTION III
Whenever a member of the Board of Trustees, administrative officer, professor, teacher, or instructor is not in complete accord with the foregoing Doctrinal Basis (set forth in the preceding statements, Sections 1 and 2), he or she shall forthwith withdraw from the Board and all positions and connections with the University, and his or her failure to do so shall constitute grounds for his or her immediate removal from such positions by the Trustees. Recognizing the validity of the Christian faith and dedicated to Christian living, the instructor is given freedom to pursue his or her studies and present his or her teaching as he or she wishes. A non-Baptist faculty member shall not be required to subscribe to the statements regarding the mode of water baptism.
S TA N D A R D S O F C O N D U C T
As a Christian university and a Christian community, Eastern is concerned with establishing standards of conduct consistent with a Christian life-style. We believe these standards flow from biblical values and from our commitment to be witnesses to one another. We also believe these standards are in the best interest of each individual student as well as the community as a whole. Believing that freedom is essential to Christian growth and maturity, the University limits its rules and regulations to those considered essential to the community's well being. The following are specific violations of University policy and will result in disciplinary proceedings: 1. All forms of dishonesty, including cheating, plagiarism, furnishing false information to the University, altering documents with the intent to defraud. 2. The use, sale, distribution, and/or the possession of marijuana and other illegal drugs. 3. The use of tobacco products. The campus is smoke-free. 4. The use or possession of alcoholic beverages on campus or in areas immediately adjacent to the campus, including Fenimore Woods and adjacent properties. 5. Returning to campus intoxicated. 6. Unauthorized visitation of members of the opposite sex in men's and women's residence halls. Students who violate expectations and standards are accountable for their behavior. The principle of accountability is basic to providing a climate which encourages students to take responsibility for their own choices. Students can expect to be confronted, counseled, and when warranted, disciplined. In order to provide a climate of trust and trustworthiness, the University, through the Dean of Students, is committed to the principle of due process. Practices in disciplinary cases may vary in formality with the gravity of the offense and the sanctions applied. Students are expected to read and abide by the Student Handbook.
EASTERN UNIVERSITY n UNDERGRADUATE ADMISSIONS OFFICE n 1300 EAGLE ROAD n ST. DAVIDS, PA 19087-3696 PHONE: 1-800-452-0996 n FAX: 610-341-1723 n E-MAIL: ugadm@eastern.edu n www.eastern.edu
Page 1
EASTERN UNIVERSITY Sponsors Commitment of Finances Form INSTRUCTIONS TO THE SPONSOR: Thank you for your commitment to support financially the education of the following prospective student who has applied to Eastern University. NAME OF PROSPECTIVE STUDENT _____________________________________________________ DEGREE PROGRAM (to which the student is applying)________________________________________ This program is usually completed in ______________ # years. Please read the instructions below and complete the five steps. Please type or print in ink. 1. Provide information about yourself and the person you intend to support on the second page of this Sponsors Commitment of Financial Support form. Indicate the specific amount of money (U.S. dollars) you will commit for each year of the students education on the same form. The length of the students degree program determines how many years of funding are necessary. This commitment is not just a formality on paper. Eastern University expects sponsors to pay their annual pledges starting a few months before the students arrival. Please attach an official bank statement or other proof of assets to confirm the availability of the funds you are pledging. Notarize both documents (Sponsors Commitment of Financial Support and Bank Statement) by obtaining an official stamp or seal from the appropriate bank officer of legal authority. In the U.S. please request this service from a public notary. Submit these documents to the admissions office of Eastern University. We suggest you make copies for your records. It is not necessary to return this sheet of instructions.
2.
3.
4.
5.
6.
Revised 01/10/07
Eastern University International Student Services
Page 2
EASTERN UNIVERSITY
Sponsors Commitment of Finances Form
I, _______________________________________________________________________________________________, Full Name of Sponsor residing at ________________________________________________________________________________________ Street and Number _________________________________________________________________________________________________ City, State, Zip, Country execute this affidavit on behalf of the following prospective student: _______________________________________________________________________________ Name of Prospective Student _______ _______ Sex Age
___________________________________________________ _____________ ____________________________ Country of Citizenship Marital Status Relationship to Sponsor ______________________________________________________________________________________________ Present Residence: Street and Number City State Country
Names of spouse and children accompanying the prospective student. ( Do not include names of family members if student will come alone): ____________________________________________________________________________ Spouse ____________________________________________________________________________ Child ____________________________________________________________________________ Child _______ ________ Sex Date of Birth _______ ________ Sex Date of Birth _______ ________ Sex Date of Birth
I agree to support financially the education of the aforementioned individual according to the terms specified below. I list amounts in U.S. Dollars. Also, with this form, I submit proof of assets verifying that the funds indicated are available for distribution. Both are notarized. YEAR 1st 2nd 3rd 4th 5th TOTAL AMOUNT OF SUPPORT $ ____________________USD $ ____________________ USD $ ____________________USD $ ____________________USD $ ____________________USD $ ____________________USD YES ____________ NO ____________ ROUND-TRIP AIRFARE GUARANTEE
SPONSORS SIGNATURE __________________________________________ DATE ___________________ Phone # __________________________Fax #_______________________ E-Mail________________________ Revised 01/10/07 Eastern University International Student Services
EASTERNUNIVERSITY InternationalStudentTransferForm FOREIGNSTUDENT: This form is required of all international students who are transferring their visa to EasternUniversity.Inadditiontothisform,werequestyousendcopiesofcurrentI20, visa,passportandI94forms.PleaseasktheForeignStudentAdviserattheschoolyou currently attend, that is the school that holds your SEVIS record, to complete the informationbelow.Heorsheshouldthensendtheformdirectlyto:
KathyKautzdeArango,InternationalStudentServices EasternUniversity 1300EagleRoad,St.Davids,PA19087 Tel.(610)3415870Fax.(610)3411705kkautz2@eastern.edu
ApplicantsFullName:__________________________DateofBirth:_____________ IauthorizethetransferofmySEVISrecordtoEasternUniversity. Signature:______________________________________________________________ FOREIGNSTUDENTADVISER: The student named above is applying for admission to Eastern University. Would you kindlycompletetherequestedinformationbelowandreturnittotheaddressabove. I94AdmissionNo.____________________________VisaType:__________________ ProgramenddateonI20:______________________SEVISNo.___________________ IstheSEVISrecordstillvalidorisitterminated/completed?_______________________ Is/wasstudentpursuingafullcourseofstudy?_________________________________ AnyproblemsregardingthestudentsstatuswithUSCIS?(pleaseexplain) _______________________________________________________________________ _______________________________________________________________________ Icertifythattothebestofmyknowledge,theaboveinformationiscorrect. Signature______________________________________Date____________________ NameandTitle(pleaseprint)_______________________________________________ Institution______________________________________________________________ Address________________________________________________________________ TelephoneNo._________________________Email___________________________ SEVISRECORDTRANSFERRELEASEDATE:_____________________________________ EasternUniversity,St.Davids,PASEVISID#PHI214F00444000
Eastern University Student Standards of Conduct As a Christian University and a Christian community, Eastern is concerned with establishing standards of conduct consistent with a Christian life-style. We believe these standards flow from biblical values and from our commitment to be witnesses to one another. We also believe these standards are in the best interests of each individual student as well as the community as a whole. Believing that freedom is essential to Christian growth and maturity, the University limits its rules and regulations to those considered essential to community well being. The following are specific violations of college policy and will result in disciplinary proceedings: 1. All forms of dishonesty, including cheating, plagiarism, furnishing false information or altering documents with the intent to defraud. 2. The use, sale, distribution, and/or the possession of marijuana and other illegal drugs. The improper use of prescription drugs. 3. The use of tobacco products. The campus is completely tobacco free. 4. The use or possession of alcoholic beverages on campus or in areas immediately adjacent to the campus, including area colleges and parks. 5. Inappropriate behavior including returning to campus drunk, intoxicated, or under the influence of alcohol, intimidation of others, threats, violations of the law on or off campus. 6. Unauthorized visitation of members of the opposite sex in mens and womens residence halls.
Students who violate these expectations and standards are accountable for their behavior. The principle of accountability is basic to providing a climate which encourages students to take responsibility for their choices and actions. Students can expect to be confronted, counseled, advised, and when warranted, disciplined. In order to provide a climate of trust and trustworthiness, the University, through the Dean of Students, is committed to the principle of due process for all students. Practices in disciplinary cases may vary in formality with the gravity of the offense and the sanctions to be applied. These items listed above represent a general overview of the student conduct standards at Eastern University. The Student handbook outlines these things in more detail.
To review the full Eastern University Student Handbook go to: http://www.eastern.edu/campus/studev/StudentHandbook/Title_TableofContents.shtml
I have read the above statement and understand it. I agree to honor the student conduct code at Eastern University. Signature_______________________________________ Date _____________
HOUSING REQUEST AND CONTRACT

EASTERN UNIVERSTIY ESLI STUDENTS Kindly read this document fully, fill out all information and sign both sides. Return this to your recruiter or representative with all your other materials. If you are accepted into the program, this form will be sent to Eastern University and housing will be held for you. We look forward to seeing you in America! Please acknowledge the following:
I have accepted admission to ESLI through Eastern University and request to be placed in housing beginning at the time of my arrival for ESLI at Eastern University. I have read and understand the student code of conduct and agree to live under the guidelines of the University. (See reverse and sign after reading.) I understand that I can request, in order of preference below, certain types of housing that have different costs. I understand that I will be placed according to the housing options that are available at the time that I am accepted into the ESLI program. Once I move into housing, I understand that I must pay both room and board for the remainder of the full academic term, even if, for any reason, I move out early. I know that my medical history, immunization record, and evidence of a physical in the past year must be received by ESLI 30 days prior to the day I arrive to move into University housing. If my schooling or housing plans change after this form is returned I understand that I must notify ESLI directly in writing. I know that a full meal plan is required for all ESLI students in housing.
For all housing questions, please contact esli@esli.intl.com. ROOM CHOICE Please make your room choices by placing the number 1 (first choice) to 4 (last choice) in front of the room type listed. Room types are listed in order of least expensive to most expensive. ___ Basic Rate Room - One to three roommates share a bathroom with other students on the hall. ___ Suite - One to three roommates who share a semi-private, bathroom located in the suite. ___ Suite with private living area Same as suite except there is a living room within the suite. ___ Single Room (Very few available) A Single Room Fee is added to the room type charges. ___ Mark X here if you would like us to choose a room for you. To help with my room placement: Indicate yes or no, answer the question or circle the right answer. I am: Male Female I am: _____ years old. My birthday is: Month ________ Day ____ Year _____ I need to keep my living area VERY neat: Yes I do. No I do not. A messy room does not bother me.
I have allergies or disabilities. No Yes: Describe ____________________________________________ When I am not studying I like to spend my time: ____________________________________________ I have a talent or hobby it is: _____________________________________________________________
Name (print) _________________________________________________________ Signature ______________________________________ Date _______________
EASTERN UNIVERSITY ~ HEALTH CENTER

Pre-Entrance Health Record Requirements for International Students
PLEASE ATTEND TO THIS IMMEDIATELY YOU CANNOT BE ADMITTED/REGISTERED AND YOUR ENROLLMENT IS NOT COMPLETE UNTIL THIS REQUIREMENT IS MET. Attached are the required health forms for full-time, International Students at Eastern University. Universities in the United States are required to secure documents concerning health and immunizations for all students. Although this information is required, it remains confidential to the Eastern University Health Center. It is essential that you have these forms completed by your physician or Health Care Provider as soon as possible and return them to the address below, promptly. ESLI 4528 Humphrey Hill Road Sedro Woolley, WA 98284 USA Forms and information needed: 1. Health History FORM Must be filled out in full. 2. Physical Exam FORM The exam must be recent (within the past six months) and signed by a medical professional with contact information listed. Chest XRay Report This must be dated within the last six months and written in English. 3. Proof of Immunizations FORM Must include the following with accurate dates of administration: Varicella (chicken pox) Indicate date of disease or vaccination (2 doses) Tetanus booster-Date must be within 10 years Measles, Mumps, Rubella (2 doses) Hepatitis B (3 doses) Limiting the spread of tuberculosis is of particular concern in the US. f If you are currently working or have worked in any healthcare field as a nurse or other healthcare worker at any time, BLOOD TITERS written in English ARE REQUIRED. A PPD skin test will be administered by the Health Center at the University to all students upon arrival as a follow-up. If you have recent, dated chest x-rays, you are encouraged to bring a report, written in English with you to the Health Center when you come.
These documents must be returned to ESLI a minimum of one month prior to the term start date. Failure to submit these documents may cause an I-20 to be revoked and unable to register. Faxed documents are accepted to meet deadlines; however originals should be brought with you if you fax them.
Health Insurance is required of all International Students Personal Health Insurance with a minimum coverage level of $50,000 is required to insure adequate medical care as needed during your time as a student at Eastern. All students are automatically billed for medical insurance provided by Eastern University. You can view the Eastern University Student Health Insurance program and policy on the web at: http://www.eastern.edu/centers/health_center/forms/brochure2007.pdf
We eagerly look forward to welcoming you when you arrive for your studies with us.
Sincerely, Judith Cocking, RN, M.Ed. Director Student Health Center
Term: F_ Sp_ Su_
year_200__
EASTERN UNIVERSITY
1300 EAGLE ROAD, ST. DAVIDS, PA 19087-3696
To the Student: YOU HAVE BEEN ACCEPTED TO EASTERN UNIVERSITY. Information you provide here will not be used to influence your situation at the University but will be used as an aid to providing necessary health care while you are a student. This information is strictly for the use of Student Health Services and will not be released to anyone without your knowledge and consent except in emergency situations. Complete this form, have your doctor sign it and return this form by mail to ESLI Student Health Services, Eastern University, by mail or FAX it to : 360-724-0548
_______________________________________________________________
LAST NAME (Print) FIRST NAME MIDDLE INITIAL SOCIAL SECURITY NO.__________________________ Home Address:__________________________________________________________________________________DOB:_______________ ______________ ____________________________________________________ Home Phone __________________________ Emergency Phone _________________________________ Cell Phone FAMILY HISTORY Age State of Health Occupation Age/Cause of Death Diabetes Heart Disease/Stroke/High Blood Pressure Cancer Asthma/Allergies Tuberculosis Alcohol/Drug Problem Depression Have any of your relatives ever had any of the following: Yes No Relationship
Father * Mother Brother(s)
Sister(s)
PERSONAL HISTORY ANSWER ALL QUESTIONS Please comment on all yes answers. Have you had? Chicken Pox Measles German Measles Mumps Mononucleosis More than 10 lb. weight gain or loss in past year Females: menstrual problems Have you had? Dental problems Eye problems Ear, nose, throat problems Asthma Penicillin allergy Sulfa allergy Other allergies Have you had? Head injury or Concussion Epilepsy/ seizures Migraines Anxiety or depression Sleep difficulty Eating disorder Alcohol/drug problem Learning disability List other allergies here: Have you had? Diseases/injury of joints Back problems Heart trouble/high blood pressure Stomach/intestinal problems Liver or kidney problems Skin problems Tumors or cysts Cancer Diabetes
Yes
No
Yes
No
Yes
No
Yes
No
Check One Do you drink alcohol? Do you smoke cigarettes, cigars or use smokeless tobacco? Do you take medications on a regular basis? (List) EASTERN UNIVERSITY Has your physical activity been restricted during the past five years? (Explain) Have you received treatment or counseling for alcohol or drug abuse, an eating disorder, depression or any other emotional problem? (Explain) Have you ever been hospitalized for any of the above? Have you had any significant illness or injury for which you have been treated or hospitalized other than already mentioned? (Explain) Do you have any questions in regard to your health, family history, or other matters:
Yes
No
PHYSICAL EXAMINATION RECORD
HEALTH INSURANCE INFORMATION All students are required to have health insurance. 1.
________________________________ ________________________________
SEX:
Health Insurance Company ____________________________________________________________________
2. Policy Holders LAST NAME (PRINT) Name _________________________________________________________________________ FIRST NAME MIDDLE 3. Policy # _____________________________ Group # ____________________
PHYSICAL EXAMINATION BY A DOCTOR

TO THE EXAMINER: PLEASE REVIEW THE STUDENTS HISTORY (reverse) AND COMPLETE THE PHYSICAL EXAMINATION AND IMMUNIZATION RECORD. PLEASE COMMENT ON ALL YES ANSWERS.
Blood Pressure ________
Pulse ________
Height in inches ____ Weight ________ lbs. Describe fully. Comment on all positive Use additional sheet if needed. COMMENTS
Are there abnormalities in the following systems? answers. System Abnormalities? Yes No Head, Ears, Nose, Throat Eyes Respiratory Cardiovascular Gastrointestinal Genitourinary Musculoskeletal Metabolic/Endocrine Neurological Skin Psychiatric (current or past)
Is the patient under treatment for any medical or emotional condition? Yes ___
No ___
Diagnosis or condition:_____________________________________________________________________ Is the patient currently taking any medication on a regular basis? Yes ____ No ____ List medications: _____________________________________________________________________________ Is there a loss of or seriously impaired function of any organ? Yes ___ No ___ Describe: _____________________________________________________________________________ Recommendations for physical activity:(sports, physical education) Yes ____ No ____
Explain: _____________________________________________________________________________________ Do you have any recommendations for the care of this student? Yes ___ Explain: No ____
HEALTH CARE PROVIDER NAME (print) _____________________________________________________________ ADDRESS _____________________________________________________________________________________ _________________________________________________________ PHONE _______________________________
Health Care Providers Signature ___________________________________________ DATE___________________
EASTERN UNIVERSITY
Health Center PART I
Name ______________________________________
Last Name
_________________________________________
First Name
Address_______________________________________________________________________________
Street City State Zip
Date of Entry ___/___

M Y
Date of Birth __/__/__

M D Y
Social Security Number __/__/__/--/__/__/--/__/__/__/__ Undergraduate ____ Professional ____
Status Part -time ____
Full-time ____
Graduate ____
PART II - TO BE COMPLETED AND SIGNED BY YOUR HEALTH CARE PROVIDER.

All information must be in English.
A. M.M.R. (MEASLES, MUMPS, RUBELLA)

(Two doses required at least 28 days apart for students born after 1956 and all health sciences students.) 1. 2. Dose 1 given at age 12 months or later #1 __/__/__ Dose 2 given at least 28 days after first dose.. #2 __/__/__
M D Y M D Y
B. POLIO
(Primary series, doses at least 28 days apart. Three primary series are acceptable. See ACIP website for details.) 1. OPV alone (oral Sabin three doses): 2. IPV/OPV sequential:
M D
#1 __/__/__
M D Y Y M D
#2 __/__/__
M D Y Y M
#3 __/__/__
M D Y D Y M D Y
IPV #1 __/__/__ IPV #2 __/__/__ OPV #3 __/__/__ OPV #4 __/__/__ #1 __/__/__

M D Y
3. IPV alone (injected Salk four doses):
#2 __/__/__
M D Y
#3 __/__/__
M D Y
#4 __/__/__
M D Y
C. VARICELLA
(Birth in the U.S. before 1980, a history of chicken pox, a positive varicella antibody, or two doses of vaccine meets the requirement.) 1. 2. 3. History of Disease Varicella antibody Yes_____ ___/___/___
M D Y
No_____
or
Birth in U.S. before 1980
Yes_____
No_____
Result: Reactive________ Non-reactive________
Immunization a. Dose #1
#1 __/__/__
M D Y
b. Dose #2 given at least 12 weeks after first dose ages 1-12 years #2 __/__/__ and at least 4 weeks after first dose if age 13 years or older. M D Y
D. TETANUS-DIPTHERIA-PERTUSSIS
(Primary series with DTaP, DTP, DT, or Td, and booster with Td or Tdap in the last ten years. Health sciences students with patient contact should receive on dose of Tdap at an interval as short as 2 years since last Td as appropriate. Refer to ACIP for details.) 1. Primary series of four doses with DTaP, DTP, DT, or Td: #1 ___/___/___ #2 ___/___/___ #3 ___/___/___
M D Y M D Y M D Y
#4 ___/___/___
M D Y
2.
Booster: Tdap (preferred) to replace a single dose of Td for booster immunization at least 2-5 years since last dose of Td, depending on age of patient. (Administer with MCV4 simultaneously if possible). .. ___/___/___
M M D D Y
3.
Booster: Td within the last ten years...
___/___/___
Y
(continued)
IMMUNIZATION RECORD (CONTD.)

E. QUADRIVALENT HUMAN PAPILLOMAVIRUS VACCINE (HPV)
(Three doses of vaccine for female college students 11-26 years of age at 0, 2, and 6 month intervals.) Immunization (HPV) a. Dose #1 __/__/__ b. Dose #2 __/__/__ c. Dose #3 __/__/__
M D Y M D Y M D Y
F. INFLUENZA
(Trivalent inactivated influenza vaccine or TIV. Live attenuated influenza vaccine or LAIV; license for healthy, non-pregnant persons age 5-49 years old. Annual im munization recommended to avoid influenza complications in high -risk patients, to avoid disruption to academic activities, and to limit transmission to high -risk individuals. Health sciences students with patient contact.) Date __/__/__ __/__/__ __/__/__ __/__/__ __/__/__
M D Y M D Y M D Y M D Y M D Y
TIV___ LAIV___
TIV___ LAIV___
TIV___ LAIV___
TIV___ LAIV___
TIV___ LAIV___
G. HEPATITIS A
1. Immunization (hepatitis A) a. Dose #1 __/__/__
M D Y
b. Dose #2 __/__/__
M D Y
2.
Immunization (Combined hepatitis A and B vaccine) a. Dose #1 __/__/__ b. Dose #2 __/__/__

M D Y M D Y
c. Dose #3 __/__/__
M D Y
H. HEPATITIS B
(All college and health science students. Three doses of vaccine or t wo doses of adult vaccine in adolescents 11-15 years of age, or a positive hepatitis B surface antibody meets the requirement.) 1. Immunization (hepatitis B) a. Dose #1 __/__/__
M D Y Adult Formation ____ Child Formation ____
b. Dose #2 __/__/__
c. Dose #3 __/__/__
2.
Immunization (Combined hepatitis A and B vaccine) a. Dose #1 __/__/__ b. Dose #2 __/__/__

M D Y M D Y
c. Dose #3 __/__/__
M D Y
3.
Hepatitis B surface antibody
Date __/__/__ Result: Reactive _____ Non-reactive _____

M D Y
I. PNEUMOCOCCAL POLYSACCHARIDE VACCINE

(One dose for members of high -risk groups.) Date
__/__/__
M D Y
J. MENINGOCOCCAL TETRAVALENT
(A,C,Y,W-135 / One dose for college freshman living in college dormitories/residence halls, persons with terminal complement deficiencies or asplenia, laboratory personnel with exposure to aerosolized meningococci, and travelers to hyperendemic or endemic areas of the world. Non-freshmen college students under 25 years of age may choose to be vaccinated to reduce their risk of meningococcal disease.) Tetravalent conjugate (preferred; data for revaccination pending; administer simultaneously with Tdap if possible): Date __/__/__ Tetravalent polysaccharide (acceptable if conjugate not available; revaccinate ever 3-5 yrs. if increased risk continues):
M D Y
Date __/__/__
M D Y
__/__/__
M D Y
(continued)
IMMUNIZATION RECORD
K. TUBERCULOSIS SCREENING 1 (done within 6 months of entry)
Tuberculin Skin Test: Date Given: __/__/__
M D Y
(CONTD.)
Date Read: __/__/__

M D Y
Result: _________ (Record actual mm or induration, transverse diameter; if no induration, write 0) Interpretation (based on mm of induration as well as risk factors): positive______ negative ______ Chest x-ray (required if tuberculin skin test is positive) result: normal_____ abnormal______ Date of chest x-ray: __/__/__
M D Y
HEALTH CARE PROVIDER

Name____________________________________________ Address_________________________________________________ Signature__________________________________________ Phone ( )____________________________________________
__________________________________________________________________________________________________________
1
The American College Health Association has published guidelines on tuberculosis screening of college and university students. These guidelines are based on recommendations from the Centers for Disease Control and the American Thoracic Society. For more information, visit www.acha.org or refer to the CDCs Core Curriculum on Tuberculosis available at state health departments or at the following website: www.cdc.gov/nchstp/tb/pubs/corecurr/.
2
Categories of high-risk students include those students who have arrived within the past 5 years from countries where TB is endemic. It is easier to identify countries of low rather than high TB prevalence. Therefore, students should undergo TB screening if they have arrived from countries EXCEPT those on the following list: Canada, Jamaica, Saint Kitts and Nevis, Saint Lucia, USA, Virgin Islands (USA), Belgium, Denmark, Finland, France, Germany, Greece, Iceland, Ireland, Italy, Liechtenstein, Luxembourg, Malta, Monaco, Netherlands, Norway, San Marino, Sweden, Switzerland, United Kingdom, American Samoa, Australia, or New Zealand. Other categories of high-risk students include those with HIV infection, who inject drugs, who have resided in, volunteered in, or worked in high-risk congregate settings such as prisons, nursing homes, hospitals, residential facilities for patients with AIDS, or homeless shelters; and those who have clinical conditions such as diabetes, chronic renal failure, leukemia or lymphomas, low body weight, gastrectomy, and jejunoileal by-pass, chronic malabsorption syndromes, prolonged corticosteroid therapy (e.g., prednisone 15 mg/d for 1 month) or other immunosuppressive disorders. ____________________________________________________________________________________________________________
APPLICATION FOR EVALUATION OF FOREIGN EDUCATIONAL CREDENTIALS
Address: P.O. Box 514070 Milwaukee WI 53203-3470 USA Phone: 414.289.3400 Fax: 414.289.3411 Website: www.ece.org Email: eval@ece.org
1. Person whose educational credentials are to be evaluated
Print clearly in black or blue ink
Name __________________________________________________________________________________________________________
(print last or family name) (print first name) (print middle name)
_________________________________________________________________ E-Mail address ______________________________________________

(print previously used names)
Applicants direct-mailing address____ESLI________________________4528 Humphrey Hill Road_______________________________________

(in care of) (number & street) (apt.)
____________________Sedro Woolley, WA_________________________________________98284______________________________USA_______

(print city & state) (zip or postal code) (country)
Tel. Day: ( _360__) __724-0547_________________ Tel. Evening: ( ______) _____________________________ Fax: ( 360__) __724-0548_________ Birthdate: day _______ month _______ year __________ In what country were the educational institutions located? ________________________________ Male Female Has this person submitted credentials to ECE before? No Yes If yes, Reference Number assigned: _________________________
Have arrangements been made to have a foreign educational institution mail credentials directly to ECE? No Yes
If yes, how is your name spelled on these credentials? ___________________________________________________________________________________________
2. Types of evaluation reports & services

Check () the type of evaluation report needed and fill in the amount. General General with 1-day rush service
includes General report fee and courier delivery
3. Purpose of evaluation
__________ __________ _135.00___ __________ __________ __________
Check () all that apply
$85 $270 $135 $175 $225 $250
Further education: Freshman Undergraduate or Transfer Graduate Field of Study ____________________________________________ Desired Institution(s) _______________________________________ Professional Licensure State:___________ Profession: ___________________________ Employment Immigration Military Other: ___________________________
3 Course-by-Course Subject Analysis Catalog Match Health Professions Licensure
Check () the additional services needed and fill in the extra amount. Rush Service (check one) 3 5 Business days (instructions p. 3) 12 Business days (instructions p. 3) Unofficial copy sent via fax: Fax number _______ - ________ - ___________ Courier Delivery to: (US and Canada - $35) (International - $50) Address in item 1 Address in item 4 __________ __________ TOTAL _$210.00__ Method of Payment Extra copies of evaluation report $10 each x __________ = $10 $75 $45 ____75_ __________ __________ __________
4. Evaluation report mailing instructions

3 Mail both copies of the evaluation report to the mailing address in item 1 above. Mail one copy of the evaluation report to the address in item 1 above, and one copy to the address below. (If you list more than one address below, a $10 copy fee is required for each extra address. Attach an additional sheet if necessary.) Check here if additional addresses are on a separate sheet.
__________________________________________________________ __________________________________________________________
Check or Money Order enclosed payable to ECE VISA MASTERCARD Exp. Date __________________________________ Card # ___________________________________________________________ Cardholders Signature ______________________________________________ Cardholders name (please print) ______________________________________ Billing Address (if different from item 1) _________________________________ ________________________________________________________________
__ ___________________________________________________________________
APP-ENG rev. 08-05
__________________________________________________________ __________________________________________________________ __________________________________________________________
5. Educational history
List all educational institutions attended, beginning with the first year of primary school and ending with the last year of education (including the school in which you are currently enrolled, if any). Print the name of each certificate, diploma, or title in English and in the native language. Add additional sheets if necessary. Name of Institution
___________________________ ___________________________ ___________________________ ___________________________ ___________________________
City & Country

_________________________ _________________________ _________________________ _________________________ _________________________
Dates of Attendance From To

___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________
Name of Diploma, Certificate or Title awarded (if any)

________________________________ ________________________________ ________________________________ ________________________________ ________________________________
FEES Payment must be made in U.S. dollars by money order, check, or credit card (Visa or Mastercard). If the money order or check is issued by a bank outside of the U.S., it must contain the printed name of the U.S. bank with which the bank is affiliated. We cannot accept bank drafts or cash. All fees are subject to change without notice. REFUNDS A refund will be made only when an applicant has paid to ECE more than the cost of the evaluation report prepared by ECE. No refund will be made when an application is canceled after the application form has been submitted, or when all required documentation is not provided. OTHER IMPORTANT INFORMATION ECE reserves the right to contact educational and governmental institutions and agencies for additional information and/or verification of the authenticity of the credentials submitted. ECE guarantees that each evaluation report will be prepared by its qualified professional staff. Equivalency conclusions stated in the evaluation report reflect the judgment of ECE based on in-depth research of applied comparative education. If ECE determines that the education completed is not the equivalent of credit course work offered by a regionally-accredited postsecondary institution in the United States, a General evaluation report will be prepared. If a Course-by-Course, Subject Analysis, Catalog Match, or Health Professions Licensure report was requested, the difference in cost between the report requested and a General report will be refunded. Education is dynamic, and changes occur in all countries. ECE's ongoing research may identify new equivalents for certain credentials from other countries, resulting in different statements of equivalence than were provided prior to the completion of such research. It is understood that all previous evaluation reports will have been based on the best information available to professionals in applied comparative education in the United States at that time. If copies of an evaluation report are requested at a later time, ECE has no obligation to review or revise the report in accordance with any changes that may have occurred in the interim.
6. Certification
I certify that all of the information provided on the application is complete and correct to the best of my knowledge. I certify that I have read all of the information appearing on the application and instructions, and that I accept the terms and conditions stated therein. I understand that evaluation reports prepared by Educational Credential Evaluators, Inc. are advisory, and are not binding on any institution, organization, or agency which may use them. I release Educational Credential Evaluators, Inc. from any liability for damages resulting from the use of an evaluation report by me or any third party. I release Educational Credential Evaluators, Inc. from any liability for damage to or loss of any documents submitted. I understand that the information provided by Educational Credential Evaluators, Inc. on the application and instructions is subject to change without notice. I understand that if false information or forged, altered, or falsified documents are submitted to ECE at any time, no evaluation report will be prepared, no refund will be made, the designees for copies of the report will be notified, and the information will be shared with academic institutions, government agencies, professional organizations and other evaluation services. This application creates a contract between Educational Credential Evaluators, Inc. and the person who has signed the application. If the signer is not the person whose educational credentials are being submitted for evaluation, the act of signing certifies that the signer is acting on behalf of the person whose educational credentials are involved, and has the authority to do so.
Signature ________________________________________________________________________________ Today's date ____________________

(signature is required in order to process this request for an evaluation report) Name (Printed ) _____________________________________________________________________________________________________________ If you are not the person whose educational credentials are being submitted for evaluation, what is your relationship to that person? ___________________________________________________________________________________________________________________________
Educational Credential Evaluators, Inc. P.O. Box 514070 Milwaukee WI 53203-3470 USA
Please detach this page and keep for your records
Instructions
Includes...
Each educational credential and its U.S. equivalent Grade average if the purpose is further education
Educational Credential Evaluators, Inc. P.O. Box 514070 Milwaukee WI 53203-3470 USA phone 414.289.3400 fax 414.289.3411 email: eval@ece.org
Type of Report
.........................................................................PLEASE DETACH THIS PAGE AND KEEP THE INSTRUCTIONS SECTION FOR YOUR RECORDS...........................................................................................................................................................
Suggested for...
Further education (freshman or graduate) Immigration Employment American Dental Association, Joint Commission on National Dental Examinations
General
Course-by-Course
Each educational credential and its U.S. equivalent Each postsecondary course U.S. equivalent credits and grades for each postsecondary course Grade average Identification of upper level courses
Further education (undergraduate or transfer) Employment Professional Licensure
Subject Analysis
Each educational credential and its U.S. equivalent Each postsecondary course U.S. equivalent credits and grades for each postsecondary course Information regarding course content specified by the agency or institution requiring the report Grade average Identification of upper level courses
Further education (undergraduate or transfer) Professional licensure This type of report can be prepared only when ECE received specific instructions from the agency or institution that requires it. Further education (undergraduate or transfer) This type of report can be prepared only when ECE has received specific instructions from the institution that requires it. Only two copies of the report can be prepared: one for the applicant and one for the institution American Society of Clinical Pathologists
Catalog Match
Each educational credential and its U.S. equivalent Each postsecondary course U.S. equivalent credits and grades for each postsecondary course Match of each postsecondary course to a U.S. university course catalog code Grade average Identification of upper level courses Each educational credential and its U.S. equivalent Each postsecondary course U.S. equivalent credits and grades for each postsecondary course Categorization of each postsecondary course according to guidelines specified by health professions licensing boards
Health Professions Licensure
ADDITIONAL SERVICES
Rush service - in addition to the basic fee:
1-Business day: Available for General reports only. 1-day Rush reports are completed one Business day following receipt of all required documents. Includes cost of general report and courier delivery to address in item 4. 5-Business days: Available for General, Course-by-Course, Subject Analysis, Catalog Match, and Health Professions Licensure reports. 5-day Rush reports are completed within 5 business days following receipt of all required documents. 12-Business days: Available for General, Course-by-Course, Subject Analysis, Catalog Match and Health Professions Licensure reports. 12-day Rush reports are completed within 12 business days following receipt of all required documents. Allow for reasonable mailing time if courier delivery is not requested. Extra Copies - Two copies of the evaluation report are included in the report fee. Additional copies requested with the initial application cost $10 each. Copies requested after the report has been prepared cost $30 for the first copy and $10 for each additional copy ordered at that time. Copies may be requested by the person who paid for an evaluation report, or by the person whose credentials were evaluated. ECE reserves the right to deny a request for a copy of an evaluation report after the report has been prepared. Extra copies of Catalog Match reports are not available. Courier Delivery - If you submit original documents and would like them returned via courier, please submit an additional $35 for courier delivery to the US and Canada or $50 for international courier delivery and special handling. If you do not request this service, we will return your original documents via regular mail.
FREQUENTLY ASKED QUESTIONS

What if I'm not sure what type of report to request? Contact us and we will help you determine what type of report to request. What if I submit insufficient documentation? We will contact you if we need additional documentation to prepare your evaluation report. What if it takes me a long time to collect the additional documents that you request? We will keep your application active for six months, but you may request an extension. If we don't hear from you within six months, we will inactivate your application. There is a $60 re-activation fee. If an application is inactive for six months, all documentation will be discarded. After that date, all documentation and a new evaluation fee are required. Will you return my documents? ECE will return original documentation sent in response to the instructions in item A of Required Documentation (on the next page), and any other original documentation specifically requested by ECE. You may request courier delivery for their return. All non-original documents, documents issued directly to us by academic institutions, original curricula and syllabi, and all photocopies become ECE's property and will not be returned. How long will it take to prepare my evaluation report? Most reports are prepared within three weeks of receiving all required documentation. If you need it sooner, you may request rush service for an additional fee. What if I have questions about my evaluation report after it is prepared? Write, email, fax or phone us if you have any questions. There is no fee to review your evaluation report within six months of the date it was prepared. After six months, there is a $60 re-activation fee. What if I don't include all of my education and decide at a later date that I want it added to my report? There is a $350 re-evaluation fee for evaluating academic work not included with the initial application form. What if I need two different types of evaluation reports? If two different types of evaluation reports are requested (at the same time or at different times), two evaluation fees are required.
REQUIRED DOCUMENTATION
At any time during the evaluation process, ECE reserves the right to request the following: Original documents; documents to be sent directly to ECE by issuing institutions; and/or a plan of studies that includes the units, credits, or number of hours of instruction for each subject. A. All official educational credentials issued in the official language of the country, beginning with the final year of secondary school (diploma, certificate, degree, title, transcript, grade report, study book or statement of marks). Follow the instructions in the table below. B. Photocopies of English translations. You may prepare the translations yourself, as long as they are complete, literal, word-for-word, and in the same format as the original document. No English translations will be returned. C. Subject Analysis, Catalog Match and Health Professions Licensure reports require a syllabus or other type of course descriptions to be submitted for all postsecondary academic subjects.
D.
Some institutions require original documents to be submitted directly to ECE. Please check with the institutions for specific documentation requirements.
All documents must be mailed directly to ECE from the issuing institution via the regular postal service. Documents sent via courier delivery will not be accepted. All documents must be mailed directly to ECE from the issuing institution via the regular postal service. Documents sent via courier delivery will not be accepted. One set of photocopies of all official documents, issued in English. One set of photocopies of all official documents, issued in English. All original documents in the official language of the country, one complete set of photocopies and photocopies of English translations. All original documents in the official language of the country, one complete set of photocopies and photocopies of English translations.
All original official documents, issued in English, and one complete set of photocopies.
Afghanistan Bahrain Bangladesh Bulgaria Cambodia Cameroon Canada Democratic Republic of the Congo (Former Zaire) Egypt Eritrea Ethiopia Ghana Greece Haiti India Iran Iraq Israel Japan Jordan Kenya Korea
Kuwait Liberia Malaysia Myanmar Nigeria Oman Pakistan Philippines Puerto Rico Qatar Saudi Arabia Sierra Leone Singapore Somalia Sri Lanka Sudan Taiwan Tanzania Thailand Uganda United Arab Emirates Vietnam Yemen
If you studied in a country not listed in this table, then submit clear and legible photocopies of original documents with English translations.
USA
CANADA
TEL: 360-724-0547 FAX: 360-724-0548

NAME OF STUDENT: __________________________________________________
McNeese State University

STUDENT NAME:______________________________

UNDERGRADUATE & ENGLISH______ GRADUATE & ENGLISH_________________ START DATE FOR ENGLISH____________ MAJOR AREA OF STUDY______________ This application package must include the following items: 1. A completed, signed Application for Admission (2 pages) 2. US$140 application & courier fees payable to ESLI 3. Official certified original school transcripts 4. Original certified school graduation diploma 5. Original Sponsors Bank letter showing balance available 6. ECE Application form and $210 for Official Course-by-Course Evaluation of Coursework for ALL Masters level applicants & Bachelor level applicants with prior college or university credits 7. Copy of students passport 8. Residence Hall Application 9. $325 Housing Deposit
ENGLISH ONLY
ESLI ONLY______ START DATE__________ ENDING DATE___________ This application package must include the following items: 1. A completed, signed Application for Admission (2 pages) 2. US$140 application & courier fees payable to ESLI 3. Original Sponsors Bank letter showing balance available 4. Copy of students passport
Mailing Address:
ESLI 4528 Humphrey Hill Road Sedro Woolley, Washington 98284 USA Tel: 360-724-0547 Fax: 360-724-0548 Email: esli@esli-intl.com Website: www.esli-intl.com
Name __________________________________________________________________________________________________________
_________________________________________________________________ E-Mail address ______________________________________________

Applicants direct-mailing address______
____________________________
(number & street) (apt.)
(in care of)
_________________________
(print city & state)
_________________________________________________________
(zip or postal code) (country)
Tel. Day: ( _360_____) ___724-0547______________ Tel. Evening: ( ______) _____________________________ Fax: ( _360____) _724-0548_________ Birthdate: day _______ month _______ year __________ In what country were the educational institutions located? ________________________________ Male Female Has this person submitted credentials to ECE before? No Yes If yes, Reference Number assigned: _________________________

__________ __________ ____135.00 __________ __________ __________
$85 $270 $135 $175 $225 $250
Check () the additional services needed and fill in the extra amount. Rush Service (check one) 3 5 Business days (instructions p. 3) 12 Business days (instructions p. 3) Unofficial copy sent via fax: Fax number _______ - ________ - ___________ Courier Delivery to: (US and Canada - $35) (International - $50) Address in item 1 Address in item 4 __________ __________ TOTAL ___210.00_ Method of Payment $75 $45 $10 ______75.00 __________ __________ __________

Mail both copies of the evaluation report to the mailing address in item 1 above. X Mail one copy of the evaluation report to the address in item 1 above, and one copy to the address below. (If you list more than one address below, a $10 copy fee is required for each extra address. Attach an additional sheet if necessary.) Check here if additional addresses are on a separate sheet.
__________________________________________________________ __________________
Extra copies of evaluation report $10 each x __________ =
__ ___________________________________________________________________
APP-ENG rev. 08-05
____ _ __________________________________________________________
___________________________ ___________________________ ___________________________ ___________________________ ___________________________
City & Country

_________________________ _________________________ _________________________ _________________________ _________________________

___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________

________________________________ ________________________________ ________________________________ ________________________________ ________________________________
6. Certification

Instructions
Includes...
Type of Report
Suggested for...
General
Course-by-Course
Subject Analysis
Each educational credential and its U.S. equivalent Each postsecondary course U.S. equivalent credits and grades for each postsecondary course Information regarding course content specified by the agency or institution requiring the report Grade average Identification of upper level courses Each educational credential and its U.S. equivalent Each postsecondary course U.S. equivalent credits and grades for each postsecondary course Match of each postsecondary course to a U.S. university course catalog code Grade average Identification of upper level courses Each educational credential and its U.S. equivalent Each postsecondary course U.S. equivalent credits and grades for each postsecondary course Categorization of each postsecondary course according to guidelines specified by health professions licensing boards
Catalog Match
ADDITIONAL SERVICES

D.
Proof of Immunization (Required for Admission)

LG LS TC Entered Received NOTE! All students born after 1956 who are attending MSU for the first time must complete and return this form. (Louisiana R.S. 17:170 Schools Higher Learning)
STUDENT
Name : _______________________________________________________________________________________________
(Last) (First) (M.I.)
Street Address: _______________________________________City/State/Zip: _____________________________________ Area Code/Phone:__________________________________Semester Applied: _____________________________________ SSN: __ __ __ - __ __ - __ __ __ __ Birth Date: __ __ - __ __ - __ __
P H Y S I C I A N
PHYSICIAN OR OTHER HEALTH CARE PROVIDER VERIFICATION: Dates of Immunization: DTP/Td 1st ____________________________________________ 2nd 3rd B B B ___________________________________________ ___________________________________________ ____________________________________________ ____________________________________________ ____________________________________________ MMR 1st ________________________________________ 2nd _______________________________________ Measles (Rubeola) Date of Disease: ______________________________ Serologic Test: _______________________________ Rubella Date of Disease: ______________________________ Serologic Test: _______________________________ Area Code/Phone: ____________________________ ___________________________________________
(Date)
Certifying Official: _______________________________ Name: __________________________________________ Address: ________________________________________ ________________________________________________

(Signature of physician or health care provider)
EXEMPTION
REQUEST FOR EXEMPTION: If you request exemption for medical or personal reasons, please check the appropriate blank and provide the information requested. ___________ Medical Reasons-physician statement in space provided below ___________ Personal Reasons-state reason in space provided below _______________________________________________________________________________________________ _______________________________________________________________________________________________ I understand if I claim exemption from the immunization requirement for medical or personal reasons, the University will require me to leave the campus and exclude me from class in the event of an outbreak of measles, mumps, or rubella on the campus. An outbreak is defined as one case of measles, mumps, or rubella. I will not be permitted back on campus or in class until the outbreak is over or until I submit proof of adequate immunization.
________________________________________________
(Student's Signature ) (Date)
___________________________________________
(Parent or Guardian's Signature required) (Date)
Return completed application to: MSU Applications P.O. Box 91740 Lake Charles, LA 70609-1740 (337) 475-5748 or 1-800-622-3352 ext. 5748
EEO/AA/ADA 5
LEASE APPLICATION
565 Beauregard Dr. Lake Charles, LA 70609 fax: (337) 562-6504 ph: (337) 475-5606 Name: _______________________________________________________________________________ Permanent Address: ________________________________________Cell phone: (_ _ _ ) _ _ _ - _ _ _ _ City: _____________________________ St:_________ ZIP: _______Home Phone: (_ _ _ ) _ _ _ - _ _ _ _ Local Address: ________________________________________________________________________ City: ______________________________ St:__________ ZIP: _______ Phone: (_ _ _ ) _ _ _ - _ _ _ _
Drivers License Number: ______________________________________State: _________ Social Security Number: _ _ _ - _ _ - _ _ _ _ Date of Birth: _ _ / _ _ / _ _ _ _ (mo/day/year) Age; Email Address: _____________________________________ Gender Current Class Standing at MSU (check one): Anticipated Graduation Date: ________________ Grad Senior Male Junior Female Sophomore Freshman
Anticipated Move-In Date: ____________
Parent, Guardian or Emergency Contact: (Required Information) Name: _______________________________________________ Relation:__________________________ Address: ______________________________________________________________________________ City: _________________________ St:__________ ZIP: _______ Employer: ____________________________________________ Home Phone: (_ _ _ ) _ _ _ - _ _ _ _ Work Phone: (_ _ _ ) _ _ _ - _ _ _ _
Drivers License Number: ______________________________________State: _________
Floorplan Options: Rank preferences below by placing a 1 for your 1st choice, 2 for your 2nd choice, etc. Assignments are based on availability upon receipt of completed application and security deposit.
Modern Housing ___ 4 Private Bedroom 2 Bath Apartment ___ 2 Private Bedroom 1 Bath Suite 4 Bedroom 6 Person Suite ___ 2 Bedroom Private ___ 2 Bedroom Semi Private Traditional Housing Collette Hall ___ Semi Private Room (Community Style Bathrooms) Requested Roommates _____________________ _____________________ _____________________ _____________________
INSTRUCTIONS: To complete the application process,
All fees should be in the form of (2) checks/money orders

MODERN HOUSING - $175 & $150 TRADITIONAL HOUSING - $175 & $150
Complete application and mail to address above or bring to the leasing office. MODERN $325 ($25 nonrefundable application fee and $150 reservation fee also non refundable) $150 Security Deposit (refundable) and TRADITIONAL $325 ($25 non-refundable application fee and$ 150 reservation fee also
non refundable,$150 security deposit refundable)

By signing below, I represent that:
a) b) c) d) All information contained herein is true and correct. I authorize verification of creditworthiness by means of reference and/or credit checks. My Security Deposit will be forfeited in full if my application is approved but I choose not to execute a lease agreement (applicable state laws apply) in 3 days. I understand a financially responsible Guarantor is required for every lease and that this Guarantor must also meet all approval requirements. Failure to provide a Guarantor will entitle us to refuse your application for that reason and to retain applicable fees agreed for liquidated damages. My permission is not required to lease vacant bedrooms in the apartment assigned to me. Roommate compatibility is not guaranteed.
e) f)
Applicants Signature: __________________________________ Date:_______________________ Staff Representative Signature: Date:_______________________
Please let us know if you need special accommodations
Application is for information only and does not obligate landlord to execute a lease or deliver possession to proposed resident(s).
565 Beauregard Dr. PO Box 90015 Lake Charles, LA 70609 (337) 475-5606 (337) 562-6504 fax
Guaranty of Lease
STATE OF LOUISIANA PARISH OF CALCASIEU FOR VALUE RECEIVED, and in consideration of and as an inducement for the execution and delivery of that certain Lease Agreement between COWBOY FACILITIES, INC., as LESSOR and ______________________________________________________________ as LESSEE. It is understood that Lessee is one of the parties to and has signed a Lease Agreement with Lessor, regarding the premises known as McNeese Student Housing(Unit Number identified in Lease Agreement), ____________________________________, Lake Charles, Louisiana (the "Lease"); the undersigned Guarantor, either a parent, legal guardian or indemnitor of the Lessee named herein hereby absolutely and unconditionally guarantees to Lessor, the full and prompt payment of all rent, additional rent, and any and all other sums and charges payable by Lessee under the Lease, and the Lease to be performed and observed by the Lessee. Guarantor hereby covenants and agrees that if default shall at any time be made by the Lessee in the payment of any such rent or of the covenants, terms, conditions or agreements in the Lease, the Guarantor will pay within 10 days of notification of managing agent such rent and other sums and charges to the Lessor, and/or perform and fulfill all of such terms, covenants, conditions and agreements, and will pay the Lessor all damages and expenses, including Lessors attorney's fees, that may arise in consequence of any default by the Lessee under the Lease or by the enforcement of the Guaranty. If more than one guarantor delivers the guaranty, their obligations herein shall be joint and in solido. This Guaranty is an absolute and unconditional guaranty of payment and of performance. It shall be enforceable against the Guarantor, without the necessity of any suit or proceedings on the Lessor's part of any kind or nature whatsoever against the Lessee or any other Guarantor and without the necessity of any notice of nonpayment, non-performance, non-observance, or acceptance of the Guaranty, or any other notice or demand, all of which the Guarantor hereby expressly waives. The Guarantor hereby agrees that the validity of the Guaranty and the obligations of the Guarantor hereunder shall in no way be terminated, affected, diminished or impaired by reason of the assertion of failure to assert by the Lessor against the Lessee any of the rights and remedies available to the Lessor, or by the relief of Lessee from any of the Lessee's obligations under this Lease by the rejection of the Lease in connection with proceedings under any bankruptcy law now or hereafter in effect or otherwise. This Guaranty may be enforced against Guarantor without the necessity of recourse against Lessee or any other parties responsible. Guarantor consents that any proceedings to enforce this Guaranty or related rights may be brought in any court sitting in Parish of Calcasieu, Louisiana and guarantor consents to personal jurisdiction of such courts and agrees that they may be served with process by certified mail addressed to them at the shown below. Any actions to enforce this Guaranty shall be governed by the laws of the State of Louisiana. This Guaranty shall be a continuing guaranty, and the liability of the Guarantor hereunder shall in no way be affected, modified or diminished be reason of any assignment, renewal, modification or extension of the Lease or any subleasing thereof or by reason of any modification or waiver of or change in any of the terms, covenants, conditions or provisions of the Lease, or by reason of any extensions of time that may be granted by the Lessor to the Lessee or by reason of any other accommodations, alterations, modifications or other indulgences granted by Lessor to Lessee, whether or not the Guarantor has knowledge or notice thereof. The Lease together with this Guaranty may be assigned by Lessor without notice to Guarantor. The assignment by Lessor of the Lease and/or the rents and other receipts thereof made either with or without the Guarantor's knowledge or notice shall in no manner whatsoever release the Guarantor from any liability hereunder. All of the rights and remedies of Lessor under the Lease or under this Guaranty are intended to be distinct, separate and cumulative, and no such right or remedy therein or herein shall be construed as a waiver or exclusion or any other remedy available to Lessor. This Guaranty shall be binding upon the heirs, administrators, executors, successors and assigns of the Guarantor and shall inure to the benefit of the Lessor, its successors and assigns. Guarantor hereby consents to Lessor performing a credit check on Guarantor. Guarantors social security number is #____-___-_____ and Guarantors date of birth is ___________, 19__. IN WITNESS WHEREOF, the undersigned Guarantor has executed this Guaranty of payment, under seal, this _____ day of ________________________, 20___. ________________________________ ________________________________ NOTARY PUBLIC GUARANTOR Print Name: ______________________ Print Name: ______________________ Address: ________________________ Address: _________________________
________________________________ ________________________________ Telephone: (_____) ________________ Telephone: (_____) ________________ SEAL Social Security #: __________________
Page 1
P. O. Box 90015 Lake Charles, LA 70609 phone: (337) 475-5606 fax: (337) 562-6504 msuleasing@ambling.com www.mcneesereslife.com
Roommate Profile Form

The following information will be used for roommate matching only. Please complete this form honestly so that you can avoid conflicts next year. 2008-2009 Class: Mr. or Ms. Freshman Sophmore Junior Senior Graduate Student Age: _______________________
Name: ____________________________________________
Major(s): ___________________________________________________________________________________________ Telephone Number: _____________________________ Cell Phone Number: __________________________________
E-mail Address: ______________________________________________________________________________________ Requested Roommate(s): _______________________________________________________________________________ Smoking: Drinking: I smoke. I drink. I do not smoke. I do not drink. I prefer to live in a smoke-free environment. I cannot drink, as I am not of age.
I prefer to live in an alcohol-free environment. Noise: Other people consider me to be a quiet person. Other people consider me to be a average person. Other people consider me to be a loud person. Cleaning: I prefer that the apartment be cleaned every night. I prefer that the apartment be cleaned once a week. I prefer that the apartment be cleaned every month. I prefer that the apartment be cleaned once a semester. Cooking: Studying: I plan to cook every night. I prefer to study in my bedroom. I prefer to study at the dining room table or in the living room. I prefer to study at the library, in a classroom or another on-campus building. I study 0-2 times per week. Schedule: I have mostly morning classes. I am a morning person. On most weeknights I like to: Watch TV Listen to Music On most weekends I like to: Watch TV Listen to Music I study 2-5 times per week. I have mostly evening classes. I am a night person. Go Out Talk on the Phone Go Out Talk on the Phone Study Invite Friends to Come Over Study Entertain Friends I study daily. I plan to cook once a week. I do not plan to cook.
Please list any interests, hobbies, sports, acitvites_________________________________________________________ __________________________________________________________________________________________________
MSU Housing has my permission to release this information to prospective roommates. Signature _______________________________________________ Date ________________
F-1 Student Visa Transfer Form
(The International Student Advisor at your school must complete this form)
If you are planning to attend McNeese State University and are coming from a high school or university in the United States, please ask the international student advisor at the school you are currently attending or last attended to complete this form and return it to the following address: International Student Affairs Office McNeese State University or fax to: (337) 475-5151 P.O. Box 92495 Lake Charles, LA 70609
Section I (to be completed by student)

Name_____________________________________ Date of Birth________________ I hereby grant permission to the Designated School Official at the school I am currently attending or last attended to release information regarding my enrollment to McNeese State University. ________________________________ Signature ____________________ Date
Section II (to be completed by DSO)
? Student was issued a SEVIS I-20 Form. We will change his/her SEVIS record to reflect transfer out to ? Student was NOT issued a SEVIS I-20 Form. Student does not and will not have a SEVIS record from
our school. Please complete the following: 1.) Students Admission Number ______________________________________________________ 2.) Level of education being pursued at your school _______________________________________ 3.) Students major at your school _____________________________________________________ 4.) Last semester enrolled at your institution _____________________________________________ 5.) To the best of your knowledge is the student in status with the INS________yes _________no. If no please explain _______________________________________________________________ 6.) Does the student have a pending reinstatement case with the INS?__________________________ 7.) Has the student ever been granted CPT or OPT from your institution?_______________________ If yes, please complete the following: Type of Practical Training: CPT or OPT (circle one)/ Full-time or Part time (circle one) Began ____________ Ended______________ THIS FORM WAS COMPLETED BY: Name (print)_______________________________ Title_____________________________________ McNeese State University. The release date will be____________________________________________.
Name and Address of the Institution ________________________________________________________ Phone # ________________________________ Email _________________________________________ Signature _______________________________________________ Date ________________________
USA
CANADA
TEL: 360-724-0547 FAX: 360-724-0548

NAME OF STUDENT: __________________________________________________
Morehead State University

STUDENT NAME:______________________________

UNDERGRADUATE & ENGLISH______ GRADUATE & ENGLISH____________ START DATE FOR ENGLISH____________ MAJOR AREA OF STUDY______________ This application package must include the following items: 1. A completed, signed Application for Admission (2 page MHSU Undergraduate application OR 1 page MHSU Graduate application) 2. US$140 Application & courier fees payable to ESLI 3. Official certified original school transcripts 4. Original certified school graduation diploma or degree certificate 5. Sponsors Financial Guarantee Form (signed by sponsor) 6. Bachelor level applicants with prior college or university credits: WES Application form and $212 for Official Course-by-Course Evaluation of Coursework Apply online at http://www.wes.org/application/apply_now.asp 7. Masters level applicants: ECE Application form and $210 fee for Official Detailed Evaluation of Coursework. 7. Original Sponsors Bank letter showing balance available issued within 3 months of application 8. 2 letters of recommendation (required for Graduate applicants) 9. Study Plan (required) 10 Resume (Required for all Graduate Applicants) 11 Copy of students Passport 12 Residence Hall Application
ENGLISH ONLY
ESLI ONLY______ START DATE__________ ENDING DATE___________ This application package must include the following items: 1. A completed, signed Application for Admission (2 pages) 2. US$140 application & courier fees payable to ESLI 3. Sponsors Financial Guarantee Form (signed by sponsor) 4. Original Sponsors Bank letter showing balance available issued within 3 months of application 5. Copy of students Passport AGENCY: ______________________________ COUNSELOR:___________________________ ADDRESS:______________________________ ________________________________________ CITY:______________COUNTRY:___________ TEL:_______________ FAX:________________ EMAIL:_________________________________
Mailing Address:
ESLI 4528 Humphrey Hill Road Sedro Woolley, Washington 98284 USA Tel: 360-724-0547 / Fax: 360-724-0548 Email: esli@esli-intl.com Website: www.esli-intl.com
MOREHEAD STATE UNIVERSITY

International Undergraduate Admissions Application
Office of Admissions 100 Admissions Center Morehead, KY 40351-1689
www.moreheadstate.edu
Phone: (606) 783-2000 or 1-800-585-6781 Fax: (606) 783-5038 E-mail: admissions@moreheadstate.edu
Please print or type, sign, date and return to MSU.
Section A
Legal name_______________________________________________________________________
family street street first city city middle region region
________________________________
Social Security Number country country zip zip
Permanent address____________________________________________________________________________________________________ Present/current address________________________________________________________________________________________________ E-mail address________________________________________ Fax No.______________________________ Enrollment type (check one): K Freshman K Transfer K Returning K Asian/Pacific Islander Dual citizenship: K Yes K No
Phone number___________________________ Sex: K Male K Female Ethnic origin (required for federal reporting purposes only):
month day
K Black K American Indian K Hispanic K Caucasian (white) _ _ Date of birth: _____ _____ _____ _____ _____ _____ Resident alien: K Yes K No
year
Marital status:
K Single
K Divorced
K Married
K Widowed K Associate K Baccalaureate K summer II July ______
Major___________________________________________ and degree objective:

program area of interest
Plan to enroll:
K fall August ______
K spring January ______
K summer I June ______
High school/secondary school___________________________________________________________________________________________

name city country
Graduation date: ____/____

month / year
TOEFL K Yes Michigan K Yes K father
K No K No
date taken___________ date taken___________ K spouse
ACT SAT
K Yes K Yes
K No date taken___________ K No date taken___________
Nearest relative:
K parents
K mother
K guardian
Relatives name______________________________________________________________________________________________________
family permanent address first city region middle country
Relatives address_____________________________________________________________________________________________________ Have you previously attended Morehead State? K Yes (date ______ to ______) K No
If yes, other name(s) under which your records may be filed____________________________________________________________________ Other colleges or universities attended (if applicable):
Name of Institution Address Dates
__________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ Have you ever been convicted of a criminal offense other than a traffic violation? K Yes K No If yes, explain_______________________________________________________________________________________________________ __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________
Section B
Country of birth____________________________________________ Country of nationality_____________________________________ Type of visa currently held________________________________________________________________ The U.S. dollar sum you have available for each year of study_________________________________ Mark and provide documentation of financial resources: (A) Personal or family (B) Family overseas (C) Funds from another source (specify type/source) ______________________________ ______________________________________________________________________ $ _________________________ $ _________________________ $ _________________________ Total $ _________________________
Important: Certified letter(s) and/or affidavits should accompany this form--including bank, employment, governmental, or sponsorship statements.
List name(s) of spouse and/or children coming with you: Name Age Relationship
__________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________
Morehead State University may, from time to time, desire to use my photograph and/or personal data, including academic records, for publicity purposes for the University. I have read the above statement and understand it, and hereby state that I do not object. (If you do object, you must notify the Director of University Communications in writing at 11 Allie Young Hall, Morehead, KY 40351-1689.) I agree to adhere to the rules and regulations of the University and certify that all statements in this application are true. I also understand that any misrepresentation of information will make me ineligible for admission to Morehead State University or subject to dismissal after admission has been granted.
Applicants signature______________________________________________________________________ Date_______________________
The following documents must be submitted: 1. Official undergraduate transcript(s) of prior educational work and an evaluation of the transcript(s) from World Education Services (WES). 2. Official TOEFL/ACT or SAT scores. 3. Official documentation that you will have at least $15,150 per academic year. 4. $55 U.S. application fee payable by credit card or U.S. money order. Enclose a money order or provide the charge informaton below: K MasterCard K Visa K Discover K American Express Expiration date____________ Cardholders Signature________________________________________________
Morehead State University is an affirmative action, equal opportunity, educational institution.
APPLICATION FOR ADMISSION TO GRADUATE STUDY

Social Security No. ______-_____-_________ Telephone No. (home) ______-______-________
Last (Family) No. and Street No. and Street City City First (Given) County County State State Zip Code Zip Code
(work) ______-______-________
Name ______________________________________________________________________________________________________ Present address _______________________________________________________________________________________________ Permanent address ____________________________________________________________________________________________ How long have you lived in Kentucky? __________________ E-mail address _____________________________________________ Date of birth __________________________ Name of Institution(s) Sex: K Male K Female Degree Received Date
Location (city and state)
Have you ever been convicted of a criminal offense other than a traffic violation? K Yes K No Citizenship: K U.S. K Other International students requiring I-20 must submit $55 non-refundable application fee payable to MSU. Citizenship (if non-resident alien) ________________________________________________________________________________
Country Type of Visa Date Visa Expires
Ethnic Group if American Citizen (6) K White, non-Hispanic (2) K Black, non-Hispanic (4) K Asian/Pacific Islander (5) K Hispanic (3) K American Indian or Alaskan native
This information is voluntary. If you do not provide the information, it will not affect the decision of admission.
(Morehead State University is committed to providing equal educational opportunities to all persons regardless of race, color, national origin, age, religion, sex, sexual orientation, Vietnam Era, recently separated, or other protected veteran status, or disability in its educational programs, services, activities, employment policies, and admission of students to any program of study.)
When do you plan to enter MSU? _________________________________ Have you previously enrolled or completed graduate level courses at MSU? If you answered yes, when? ______________________________________ Please list name(s) previously used as a former student _________________________________________________________________ Write in the name of the program or type of degree/non-degree certification that you are seeking to pursue (refer to back page for options): ____________________________________________________________________________________________________________ ________________________________________________________________________________
Signature
K Yes
K No
________________________
Date
The following graduate admissions documents must be submitted: 1. An official undergraduate transcript from each of the institutions you listed above (other than MSU); 2. General aptitude GRE scores, MAT or GMAT scores if youre an MBA program applicant; 3. A copy of your teaching certificate if you are seeking admission to a professional education program and/or are earning additional certificates. Return this form to:
Phone: 606-783-2039 Fax: 606-783-5061
Office of Graduate Programs Morehead State University 701 Ginger Hall Morehead, KY 40351-1689
L For Office Use Only L Entered in computer by __________________________ Student I.D. No. _______________________________ Date _____________________
WESEvaluations
IfyouhavehadANYcollegeoruniversityclassesyouMUSTcompleteaWESevaluation;thisis forBOTHUndergraduateandGraduateapplicationstoMoreheadStateUniversity.Completing aWESevaluationisasimpleprocess.Followthedirectionsbelowtocompletetheapplication. 1.GototheWESwebsite:www.wes.org 2.ClickontheApplyNowbutton. 3.Onthenextpage,clickonthewordsOnlineApplication 4.Nowthewebsitewillguideyouthroughtheprocessoftheapplication. 5.Whenselectingtheevaluationtype,youMUSTchoosetheCoursebyCourseevaluation. 6.FollowALLdirectionsgivenbyWESregardingthehandlingofyourtranscripts.Ifyoudonot followthesedirectionsWESwillnotdotheevaluation.Makesureyouhaveselectedtohavea copysenttoMoreheadStateUniversity.
Trusted Credential Evaluations

Having a WES credential evaluation can give you an advantage over other students. The WES Report demonstrates how your education compares with U.S. studies and shows your commitment to backing up your application with the facts. WES has the worlds largest database of institutions, courses and degrees, so providing a WES evaluation enables U.S. academic institutions, licensing boards and employers to review your application faster. You can submit your application with the condence that your qualications will be recognized and understood. Submitting a WES evaluation can help you make sure that your application receives a fair review based on an accurate assessment of your prior education.
INTERNATIONAL EDUCATION INTELLIGENCE
Application for
International
WORLD EDUCATION SERVICES, INC.
P.O. Box 5087 Bowling Green Station New York, NY 10274-5087 Tel: 212-966-6311 Fax: 212-739-6120 Online: wes.org/contact.asp
Academic Credential
Evaluation
wes.org/apply
INTERNATIONAL EDUCATION INTELLIGENCE

WES evaluations compare your credentials from any country in the world to those issued in the U.S. WES evaluations are widely accepted and the most trusted and requested brand of report, so you have come to the right source.
New!
About WES
World Education Services (WES) is the leading source of international education intelligence. WES is a not for pro t organization with over thirty years experience evaluating international credentials. WES provides more than 50,000 evaluations each year that are accepted by thousands of academic institutions, employers, licensing and certication boards and government agencies in the U.S. and Canada. Our robust and comprehensive credential evaluation database, known as AICES, is a powerful source of information about education systems and evaluation methodology around the world.
Need a quick idea of how your degrees are viewed in the U.S.?
International Credential Advantage Package
Go to wes.org/preview
Need a U.S. GPA?
Transcripts & Evaluation

www.wes.org/students
Go to wes.org/igpa
WES is dedicated to providing credential evaluations that are fair and accurate.
Save $20
Save $20 paper processing fee
wes.org/apply
New York Chicago Washington, D.C. San Francisco Toronto
WES Offers
Online Application at wes.org/apply Online Tracking and File Status at wes.org/appstatus Electronic delivery of documents and reports, direct to academic institutions, licensing boards and employers One Evaluation Many Uses The same WES evaluation can be used for education, licensing, employment or immigration Comprehensive Reports Reports always include all your academic credentials for one low fee Fast Service Reports are ready in just 7 business days, once we receive your application, all required documents and fees
Save $20
at wes.org/apply
Services and Fees (See website about new transcript & evaluation storage and delivery service @ www.wes.org/student/icap.)
WES evaluations are completed within seven (7) business days from the day an application, all required documents and fees are received. Fees must be paid in U.S. dollars by check/money order or credit card. Payments from outside the U.S. must be drawn on a bank located in the U.S. or by credit card. Save $20 by applying online. Paper processing fee included in these prices. Comprehensive Course-by-Course Report - $180 ($160 online) (per application, regardless of the number of documents) This comprehensive evaluation report is designed for, and preferred by, academic institutions and licensing boards. It identies each credential and gives its U.S. equivalent. In addition, it provides a breakdown of all post-secondary study in terms of U.S. semester credits, grade equivalents, a grade point average (GPA) calculated on a 4.0 scale, and designates the level of undergraduate courses. Document-by-Document Report - $120 ($100 online) (per application, regardless of the number of documents) This report identies each credential and gives its U.S. equivalent. It is generally used for employment and immigration purposes.
Rush Services & Fees
Evaluations are completed within seven (7) business days unless rush service is specied. For faster service, WES offers the following options: Same-Day The evaluation is completed and mailed within the same business day. $195 (in addition to evaluation fee) Three-Day The evaluation is completed and mailed within three (3) business days. $100 (in addition to evaluation fee)
You must select a delivery method for each recipient. Standard Delivery U.S. Postal Service @ $7 per address Overnight Delivery (U.S.) @ $30 per address, Canada @ $60 2nd Day Air (U.S. only) @ $20 per address. International Express International courier service @ $60 per address. Fax WES will send an unofcial fax evaluation report (U.S./Canada) for a fee of $5 per recipient.
Delivery Methods & Fees
Save $20
Save $20 paper processing fee
wes.org/apply
Additional Reports
Our basic service includes sending one ofcial copy of your evaluation report to you and, when requested at the time of application, one to the recipient of your choice. Additional reports requested at the time of the initial application are $25 per report. For reports requested after the evaluation has been completed, the fee is $45 for the rst report and $25 for each additional report. Sealed Envelope Service Recipients generally require that the ofcial evaluation report be sent to them directly by WES. If you are ordering additional reports that you plan to submit for ofcial purposes at a later date, we advise that you request our Sealed-Envelope Service. WES will send all additional reports to you in specially marked and sealed envelopes that most recipients will accept as ofcial. The fee for this service is $5 per report/envelope. Fees are subject to change. Fees are not refundable once an application is submitted.
To apply, go to wes.org/apply or use the application inside

Page 1
How to Submit Documents

WES adheres to rigorous documentation and evaluation procedures to prepare evaluations that are accurate and recognized in the United States. The documents that WES requires are specic to each country of education. To ensure that your evaluation is prepared without delay, please follow the instructions for your country of education as provided at: wes.org/required. WES does not accept any personal copies of documents. If personal copies are submitted, they will not be returned. Translations into English: If the academic institution that you attended does not issue documents in English, you must submit precise word-for-word translations of all your credentials. To have your documents translated, you may contact University Language Services (ULS) at <www.alsintl.com/university.htm> or call them at 800-419-4601. (Outside the U.S., call 001-212-766-4111) This information is provided for your convenience only. All arrangements must be made directly with ULS or the translator of your choice.
WES Procedures & Policies

WES evaluates only formal educational credentials issued by recognized or accredited institutions. WES reserves the right not to accept an application for evaluation. WES reserves the right to verify any documents, regardless of the manner in which they are received. WES veries the authenticity of educational credentials and will not issue an evaluation report until we are satised that all necessary credentials have been received. Furthermore, WES does not issue partial evaluation reports. All documents listed on an application must be received prior to the issuance of a report. In addition, all documents recieved by WES become our property and are not released to the applicant. Request for Additional Information or Documents If upon initial review of an application and documents, WES determines that additional documents and/or information is required, a request for the missing information is issued and the le is placed on hold until all the necessary material has been received to the satisfaction of WES. Re-Evaluations Requests for re-evaluation based on documents that were not submitted with the initial application constitute a new evaluation and a second payment of the basic fee is required. To change a previously completed document-by-document evaluation to a course-by-course report requires an additional payment of $100. From Course-by-Course to Document-by-Document If WES determines that a course-by-course evaluation cannot be prepared, a document-by-document evaluation will be issued along with a refund of the difference in fees. Document Verication Fees Academic institutions in certain countries require the payment of a fee in order to verify educational credentials. When an institution requests such a payment, WES passes the request to the applicant who must pay the fee directly to the institution. Fraudulent Documents When any document submitted with an application for evaluation is found to have been altered, tampered with or forged, WES cancels the application and retains all the documents. Fees are not refunded. WES will notify all recipients indicated on the application form as well as other appropriate authorities. Electronic Delivery - Many institutions and boards receive WES reports electronically, and in some cases this may be the only method of delivery. In such cases, standard delivery fee still applies. Fees are not refundable once an application is submitted. Returned checks are subject to an additional fee of $30. NOTE: All fees subject to change.
Newce i Serv WES ICAP

International Credential Advantage PackageStore and deliver your veried transcripts and the WES evaluation report to educational institutions. See www.wes.org/students/icap
Submitting Applications and Credentials

Save $20
Online Go to www.wes.org/apply
WES now offers an online application. Applying online is fast and convenient.
By Mail
World Education Services P.O. Box 5087, Bowling Green Station New York, NY 10274-5087
For Further Information

For more information and assistance, please visit www.wes.org, email us at www.wes.org/contact.asp or call our New York ofce: 212-966-6311 Page 2
By Express Courier
World Education Services 64 Beaver St, #146 New York, NY 10004
By Fax
212-739-6120
Apply Online at wes.org/apply, save $20 paper processing fee.

Personal Information
Name Mailing Address
City Last/Family
Please print or type. Previous/Maiden Name
First/Given Number and Street State/Province
Middle
If appearing on any of your academic credentials.
Apt./Flat Number Country Zip/Postal Code
Phone Date of Birth: (Month/Day/Year)
Fax
E-mail Sex: Yes No Male Female Social Security Number
Preferred Method of Contact:
Mail
Fax
E-mail
Have you ever submitted an application to WES? How did you hear about, or who referred you to WES?
If yes, provide WES Ref.#
List all educational institutions attended, beginning with secondary school and including the one you are currently attending.
Name of Institution Country Dates of Attendance (From - To) Name of Diploma/Certicate (in original language) I Year of Graduation
a. b. c. I have read the documentation requirements for my country of education at wes.org/required and agree to submit my credentials as instructed. (Please Initial) State
Primary Purpose of Evaluation

Education Employment
(Choose One) Immigration Professional Licensing/Certication: Field
Services and Fees Evaluation Fees
Please rst read pages 1 and 2 of this application.
Rush Evaluation Report Delivery One ofcial report will be sent to you at the address you have indicated above at no charge. Select a delivery method for shipment to your address.
Delivery Method (Required; Choose One) Standard Delivery ($7) Overnight (U.S.) ($30) 2nd Day Air (U.S. Only) ($20) Intl Express/Canada (add $60)
(Required; Choose One) Basic evaluation fee includes $20 for paper processing. Go online for less expensive options at wes.org/apply. Document-by-Document ($120) X Comprehensive Course-by-Course ($180) CPA Board Evaluation ($280)................................................................................................ $ ICAP Document-by-Document ($145) ICAP Comprehensive Course-by-Course ($205) Services (Optional) Same-day (add $195) Three-day (add $100) ...................................................................................................................................................... $
180.00
Fax (U.S. or Canada only) (add $5) .................. $
Additional Reports Sent To You (Optional) ($25 each) Number requested
x $25 ................................................................................................................................ $
Sealed Envelope Service (Optional $5 per envelope) All additional reports ordered above will be sent in separate sealed envelope(s) ..................................................................... $
Send Evaluation Reports To (See page 1 for details.) If you want a copy of the report sent to an academic institution, employer, or licensing board, please indicate their exact name(s) and address(es) below. Attach additional sheets if there are 1 x $25 more than 2 addresses. The rst report is free of charge if ordered with this application. Additional reports may be ordered for $25/report. Number requested $ 2. 1.
ESLI
25.00
4528 Humphrey Hill Road

Sedro Woolley
City
WA
State
98284
Zip City State Zip
Delivery Method For This Recipient (Required; Choose One) X Standard Delivery ($7) 2nd Day Air (U.S. Only) ($20) Overnight (U.S.) ($30) Intl Express/Canada (add $60)
Delivery Method For This Recipient (Required; Choose One) Standard Delivery ($7) Overnight (U.S.) ($30) 2nd Day Air (U.S. Only) ($20) Intl Express/Canada (add $60) $
7.00
Payment Options
Charge my: (Check one) Credit Card Number Cardholder Name and Billing Address (if different than applicant) Check / Money Order Enclosed (Please make check payable to World Education Services and attach check to application.) I certify that: All of the information provided in the application is correct. I have read the documentation requirements for my country of education at www.wes.org/required and agree to submit my credentials as instructed. I have read all the instructions and policies provided on pages 1 and 2 of this application and agree to the terms stated. I understand that the report is advisory and not binding upon any agency or institution that uses it. I understand that fees are not refundable once an application is submitted. Finally, I release World Education Services from any liability for damages resulting from the use to which I or any agency or institution puts the evaluation report. Name (printed) Signature Date VISA MasterCard American Express Discover Exp. Date
Total Amount
Signature of Cardholder (required)
212.00
2009 (2)AC
Request for Academic Records

Note to Applicant: It is the responsibility of individual applicants to have their academic records forwarded to WES. Please complete the top part of this form and submit it to the registrar/controller of examinations/or other authorized official at the academic institution where you obtained your credential(s). Print additional copies of this form if necessary. Please note that some institutions may charge a fee for this service.
WES Ref # (if applicable) Last/Family Name First/Given Name
Previous Name (if applicable)
Date of Birth (dd/mm/yyyy)
E-mail
Institution Name Degree Name (if applicable)
Dates Attended From_____________________ To ____________________ (mm/yyyy) (mm/yyyy) Year of Award (if applicable) Major
Student ID or Roll Number at sending institution (if applicable)
I hereby authorize the release of my academic records to World Education Services. Applicants Signature: Date:
Note to Authorized Official: The above-named person seeks to have his/her credentials evaluated and requests that a transcript of his/her academic records/statement of marks - showing all subjects completed and all grades/marks awarded for all years of study - be released to World Education Services. Please complete this form, place the form and academic record in an envelope, sign and seal the envelope across the back flap, and send it directly to World Education Services at one of the addresses below.
Name of Official Completing Form (Please type or print) Title
Address
City Telephone Email
Country Fax URL www.
Postal Code
Confirmation: I confirm that the student named above attended

Institution Name
Dates of attendance from

month/yr
to
month/yr
Degree obtained (if applicable) __________________________________________________

Degree Name
_____________________
Date Awarded (month/yr)
Authorized signature and SEAL
Date
Yes, the applicants academic transcript/statement of marks is attached to this form.

By Postal Mail: World Education Services P.O. Box 5087 Bowling Green Station New York, NY 10274-5087 USA By Express Courier: World Education Services 64 Beaver St. #146 New York, NY 10004 USA
(PLEASE RETURN THIS FORM TOGETHER WITH THE OFFICIAL ACADEMIC RECORDS/STATEMENT OF MARKS.)
3/09
OFFICE OF INTERNATIONAL EDUCATION
100 ADMISSIONS CENTER MOREHEAD, KY 40351 TEL: 606-783-2000 FAX: 606-783-5038
LETTER OF SUPPORT
I, ____________________, residing at _____________________________________,

Street Number City Country
am willing and able to financially support ___________________________ who is my __________________________________ for the duration of his/her studies at
Relationship
Morehead State University. I will provide the amount of _________________, which is an equivalent of US $22,000______________ .
To verify my financial ability to support the above mentioned student, I submit the appropriate financial documents:
Current original bank statement with the specific amount and date account was established.
__________________________ Sponsors Signature
________________________ Date
*All financial support documents MUST be originals. PHOTOCOPIES ARE NOT ACCEPTABLE. * All financial documents should be recently dated to qualify as proof of financial support. Financial documents dated more than 3 months prior to submission are not valid.
www.moreheadstate.edu
MSU is an affirmative action, equal opportunity, education institution.
MOREHEAD STATE UNIVERSITY HOUSING OFFICE APPLICATION FOR CAMPUS HOUSING
Please read carefully before completing your application: Morehead State University requires all full-time students under the age of 21, who have earned less than 60 University recognized college credit hours to live on campus and subscribe to an applicable dining plan. Students must be 21 by the first day of class to fulfill the residency requirement. Individuals must be admitted to MSU before submitting a housing application, and pay the required $100 deposit. Applications received without admittance to the University and/or without a deposit will not be processed. PERSONAL INFORMATION:
Last Name: Address: Gender (Circle): M / F E-Mail: Year for which you are applying: Student Status: New Classification: Returning Transfer Junior Senior Graduate Student Cell Phone: Student ID#: Term for which you are applying: Fall Spring Summer First Name: City: Home Phone: St: MI: Zip:
Freshman
Sophomore
Have you lived on campus at MSU before? Y / N
Intended Major:
Do you plan on participating in the LEAD program? Y / N

http://www.moreheadstate.edu/lead
If so, would you like to live in this community? Y / N
PERSONAL CHARACTERISTICS: The following information will be utilized to assist housing staff in making roommate assignments. I smoke I object to living with a smoker I go to bed early (before 12 a.m.) I am a night owl (after 2:00 a.m.) I am an early riser (before 7:00 a.m.) I am neat and organized most of the time I am messy/keep a lot of clutter around I prefer quiet time to study I mostly study at night I spend more than 5 hours on the computer each day I am a light sleeper I snore I am comfortable with members of the opposite sex being in my room Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No No No No No No No No No No No
Do you have any special needs which should be considered in making your housing assignment? Y / N If yes, please specify:
ROOMMATE PREFERENCES: Roommate requests must be mutually listed by all applicants- listing an individual does not guarantee room placement. Request 1: Request 2: Request 3: MSU ID# or Last 4 of Social Security#: MSU ID# or Last 4 of Social Security#: MSU ID# or Last 4 of Social Security#:
HALL PREFERENCES: Listing a preference does not guarantee placement in a requested facility. Please review eligibility requirements contained in the enclosed pamphlet prior to making facility selections. Upperclassmen students applying for apartment housing should list facility and apartment type (students interested in apartments must have at least 48 credit hours and have a cumulative GPA of 2.5). Applicants requesting facilities for which they are not eligible will be assigned to alternate facilities based upon eligibility and available spaces. PLEASE LIST YOUR TOP THREE CHOICES IN ORDER OF PREFERENCE 1. 2. 3.
MENINGITIS VACCINATION INFORMATION: In accordance with Kentucky House Bill #342 passed during the 2004 regular session, MSU is required to provide information regarding meningococcal meningitis to all students living in campus housing. Meningococcal meningitis, an inflammation of the membranes surrounding the brain and spinal cord is a rare but potentially fatal bacterial infection. MSUs Caudill Health Clinic sponsors a meningitis vaccination clinic each fall semester for a nominal charge. Additional information regarding meningococcal meningitis can be found on the Caudill Health Clinic website. (www.moreheadstate.edu.chc) HB #342 also requires that you indicate whether or not you have received the meningitis vaccination. Please indicate your vaccination status:
I have had a meningitis vaccination:
YES NO
APPLICANTS SIGNATURE:
DATE:
Please return the completed application and your $100 deposit to: Housing Office; 150 University Blvd. Box 2525; Thompson Hall; Morehead, KY 40351 Phone: (606) 783-2060 Fax: (606) 783-5062 E-Mail: housing@moreheadstate.edu
Revised 10/08
Name __________________________________________________________________________________________________________
_________________________________________________________________ E-Mail address ______________________________________________

Applicants direct-mailing address____ESLI________________________4528 Humphrey Hill Road_______________________________________

(in care of) (number & street) (apt.)
____________________Sedro Woolley, WA_________________________________________98284______________________________USA_______

(print city & state) (zip or postal code) (country)
Tel. Day: ( _360__) __724-0547_________________ Tel. Evening: ( ______) _____________________________ Fax: ( 360__) __724-0548_________ Birthdate: day _______ month _______ year __________ In what country were the educational institutions located? ________________________________ Male Female Has this person submitted credentials to ECE before? No Yes If yes, Reference Number assigned: _________________________

__________ __________ _135.00___ __________ __________ __________
$85 $270 $135 $175 $225 $250
Check () the additional services needed and fill in the extra amount. Rush Service (check one) 3 5 Business days (instructions p. 3) 12 Business days (instructions p. 3) Unofficial copy sent via fax: Fax number _______ - ________ - ___________ Courier Delivery to: (US and Canada - $35) (International - $50) Address in item 1 Address in item 4 __________ __________ TOTAL _$210.00__ Method of Payment Extra copies of evaluation report $10 each x __________ = $10 $75 $45 ____75_ __________ __________ __________

3 Mail both copies of the evaluation report to the mailing address in item 1 above. Mail one copy of the evaluation report to the address in item 1 above, and one copy to the address below. (If you list more than one address below, a $10 copy fee is required for each extra address. Attach an additional sheet if necessary.) Check here if additional addresses are on a separate sheet.
__________________________________________________________ __________________________________________________________
__ ___________________________________________________________________
APP-ENG rev. 08-05
__________________________________________________________ __________________________________________________________ __________________________________________________________
___________________________ ___________________________ ___________________________ ___________________________ ___________________________
City & Country

_________________________ _________________________ _________________________ _________________________ _________________________

___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________

________________________________ ________________________________ ________________________________ ________________________________ ________________________________
6. Certification

Instructions
Includes...
Type of Report
Suggested for...
General
Course-by-Course
Subject Analysis
Each educational credential and its U.S. equivalent Each postsecondary course U.S. equivalent credits and grades for each postsecondary course Information regarding course content specified by the agency or institution requiring the report Grade average Identification of upper level courses Each educational credential and its U.S. equivalent Each postsecondary course U.S. equivalent credits and grades for each postsecondary course Match of each postsecondary course to a U.S. university course catalog code Grade average Identification of upper level courses Each educational credential and its U.S. equivalent Each postsecondary course U.S. equivalent credits and grades for each postsecondary course Categorization of each postsecondary course according to guidelines specified by health professions licensing boards
Catalog Match
ADDITIONAL SERVICES

D.
USA
CANADA
TEL: 360-724-0547 FAX: 360-724-0548

NAME OF STUDENT: __________________________________________________
Texas A&M University Corpus Christi

A Member of Texas A&M University System
STUDENT NAME:______________________________

UNDERGRADUATE & ENGLISH______ GRADUATE & ENGLISH______ START DATE FOR ENGLISH____________ MAJOR AREA OF STUDY______________ This application package must include the following items: 1. International Student Application for Admission Form 2. US$140 application & Courier fees payable to ESLI 3. Official Original Certified original school transcripts 4. Official Original Certified School graduation diploma 5. Sponsors Financial Guarantee form, signed by sponsor 6. Original Sponsors Bank statement 7. 3 letters of recommendation (required for graduate apps) 8. Study plan (300-500 words for graduate apps) 9. Resume (required for MPA, MBA, and MAcc apps) 10 FCSA Application form and $110 fee for Official Detailed Evaluation of Coursework for ALL Masters level applicants & Bachelor level applicants with prior college or university credits. 11 Copy of students passport 12 On Campus Housing Application 13 TAMUCC Immunization Form
ENGLISH ONLY
TAMUCC/ESLI ONLY______ START DATE____________ ENDING DATE___________ This application package must include the following items: 1. International Student Application for Admission Form 2. US$140 application & Courier fees payable to ESLI 3. Sponsors Financial Guarantee form, signed by sponsor 4. Original Sponsors Bank statement 5 Copy of students passport AGENCY: ______________________________ Mailing Address: COUNSELOR:___________________________ ESLI ADDRESS:______________________________ 4528 Humphrey Hill Road ________________________________________ Sedro Woolley, WA 98284 USA CITY:______________COUNTRY:___________ Tel: 360-724-0547 TEL:_______________ FAX:________________ Fax: 360-724-0548 EMAIL:_________________________________ Email: esli@esli-intl.com
TEXAS A&M UNIVERSITY - CORPUS CHRISTI UNDERGRADUATE INTERNATIONAL STUDENT APPLICATION FOR ADMISSION
Return all admission material to: TAMUCC ESLI 4528 Humphrey Hill Road Sedro Woolley, WA 98284
For more information concerning the admission process, telephone (360)-724-0547 or fax (360) 724-0548. NOTE: A non-refundable evaluation/application fee is required with each application. Semester and year admission is desired: Semester ______________________________ Year ______________
U.S. Social Security number ___________________________________________________ Name __________________________________________________________________________________________________________________

last (family) first middle maiden
Other name(s) which might appear on previous academic records _______________________________________________________________ Permanent address in home country _________________________________________________________________________________________________________
street and number city state zip code country
Telephone number (with country code)___________________________________
E-mail address_____________________________
Current mailing address _________________________________________________________________________________________________________

Telephone number (with country code)___________________________________ Birth date ______________________________

month/day/year
E-mail address_____________________________ Gender: male_____ female_____
Marital status:
single_____ married_____
Country of birth __________________________________________
Country of citizenship ___________________________________________ yes_____ no_____ I-20 Admission number _____________
If you come to the United States, will your spouse and/or children come with you?
Students Currently in U.S.A.: Date of entry ____________ Type of visa at entry ____________
Passport number ______________ Passport issued by ________________________________ Passport valid until ______________ What institution issued the I-20 for your current visa? ____________________________________________________________________ Are you currently enrolled in the institution? yes_____ no_____ Date I-20 expires ______________________________________
EDUCATIONAL DATA
Intended major at Texas A&M University - Corpus Christi _______________________________________________________________________________ Type of degree you are seeking: bachelors degree_____ no_____ ESLI only _____ yes_____ no_____
Have you taken the ACT/SAT? yes_____ SAT scores:
Were your scores sent to TAMUCC? Total____________
Verbal ____________
Math____________
Test date __________________________
ACT score: ____________
Test date ___________________________ Were your scores sent to TAMUCC? yes_____ no_____ Test date ______________________
Have you taken the GRE/GMAT? yes_____ no_____ GRE scores: Verbal____________ GMAT total score: ____________
Quantitative____________
Analytical____________
Test date ______________________ (TAMUCC requires a TOEFL score of 550 for
Have you taken the Test of English as a Foreign Language (TOEFL)? yes_____ no_____ undergraduate students, 550 for graduate students.) Has your official TOEFL score been sent to TAMUCC? yes_____ no_____
Score __________ Test date___________________
What is your native language? _______________________________ Other languages _____________________________________________ Intensive English Students: Intensive English program only_____ ESLI start date___________________ Intensive English and degree program_____
Are you currently enrolled in an intensive English language program? yes_____ no_____
If yes, where?______________________________________________________________________________________________________ EDUCATIONAL BACKGROUND List in chronological order each school or institution you have attended; begin with secondary school and end with the present. Include each school or institution attended, the dates attended and the degrees received. If you need additional space, use a separate sheet of paper.
Type of School: Secondary, College, University, Etc. Attended From To Month/Yr Month/Yr / / / / / / / / / / / / / / / / / / / / Actual Name of Diploma, Degree or Certificate Your Date Age in Received School
Name of School or Institution and Location
How did you learn about Texas A&M University - Corpus Christi ?________________________________________________________________________ Were you referred to Texas A&M University - Corpus Christi by an agency? yes_____ no_____ Name of agency ___________________________________________________________________________________________________ Address ___________________________________________________________ Telephone ___________________________________
Provide the following information on a person (parent, guardian, relative) who could be notified in case an of emergency: Name _______________________________________________________ Relationship ________________________________________ Telephone ___________________________________
Address ___________________________________________________________ RESIDENCY INFORMATION
Texas Higher Education Coordinating Board rule 21.38 requires each student to provide substantiating documentation to affirm residence for tuition purposes. It also requires an Oath of Residency required by state law to be signed by each applicant. If you have attended school or resided out of state, additional proof of residency may be required.
OATH OF RESIDENCY
I understand that information submitted here will be relied on by University officials to determine my status for residency. I authorize the University to verify the information I have provided. I agree to notify proper institution officials of any changes. I certify that the information is complete and correct, and I understand that submission of false information is grounds for rejection of my application, withdrawal of any offer of acceptance, cancellation of enrollment or appropriate disciplinary action.
Signature of applicant _____________________________________________________________
Date _________________________________
Texas A&M University Corpus Christi serves people of all ages regardless of socioeconomic level, race, color, gender, religion, disability or national origin. TAMUCC is an affirmative action/equal employment opportunity institution. I CERTIFY THAT ALL INFORMATION CONTAINED IN THIS APPLICATION IS COMPLETE AND ACCURATE, AND I UNDERSTAND THAT SUBMISSION OF INACCURATE OR INCOMPLETE INFORMATION MAY RESULT IN TERMINATION OF MY APPLICATION, ENROLLMENT AT TEXAS A&M UNIVERSITY OR DISMISSAL FROM THE UNIVERSITY. I understand that as a student of Texas A&M University-CC, an account will be established in my name. I am aware that financial transactions will be posted to this account, and the University will extend credit to me in anticipation of payment on a prescribed due date. I understand that if I fail to repay any debt when due, I will be assessed late charges. I further agree to pay all attorneys fees and other reasonable collection costs necessary to collect amount not paid when due.
Date _________________________________
International Graduate Application for Admission

Graduate Studies and Research - 6300 Ocean Drive - Corpus Christi, Texas 78412 - (361) 825-5740 or 1-800-482-6822
Information and Requirements for Graduate Admission

The following documents are required for admission into any graduate program at Texas A&M University-Corpus Christi. 1. 2. 3. 4. The completed Application form must be accompanied by a non-refundable fee of $70.00, which must be paid in U.S. currency. Official transcripts from all undergraduate and graduate coursework must be submitted. Notarized Affidavit of Support (or I-34 form) certifying ability to finance study in the U.S. International applicants in the United States are required to provide a copy of their current visa.
Please check with your graduate program or the graduate catalog for more information concerning specific admission requirements pertaining to the program of your choice. The graduate catalog is posted at www.tamucc.edu/~gradweb. A. Applicant Information ( Please type or print clearly) Date of Birth*: _____ - _____ - _____
Month Day Year
Gender*:
Male
Female
Place of Birth*: _______________________

City
Race/Ethnicity* White, Non-Hispanic Black, Non-Hispanic Hispanic/Latino Asian, Pacific Islander Asian American Indian/Alaskan Other __________ (specify)
_________________________ State Country _________________________ Country of Citizenship

Mr. Ms. Other: _____
Full Legal Name: __________________________________________________________________

Last First Middle Maiden Suffix (Jr.,etc)
Permanent Address: _______________________________________

Number and Street
Current Address:
Apt. # Number and Street
(Only if different from permanent address)
_______________________________________
P.O.Box Apt. #
P.O.Box
_______________________________________
City State Zip County
_______________________________________
City State Zip County
(______)____________ (______) ___________

Home telephone Work telephone
(______)__________ (______) _____________

Home telephone Work telephone
E-Mail Address: ________________________________________________________________ In case of emergency, please contact: Full Name: ______________________________________ Address: ___________________________________________ Relationship: _________________ Home Telephone: (______)________________ Work Telephone: (_____)____________________
Expected Semester of Entry for ESLI: Year _______ Fall Spring Are you applying as: Degree Certificate Non-Degree Seeking (ESLI only__________)
Summer I(June)
Summer II(July)
This information is for state and federal reporting purposes and will not be used in any admission decision.
Students Currently in U.S.A.:
Date of entry:________ Type of Visa at entry_______ I-20 Admission number__________
Passport number_______________ Passport issued by _________________ Passport valid until________________ What institution issued the I-20 for your current visa? ___________________________________________________ Are you currently enrolled in the institution? Yes_____ No_____ Date I-20 expires_________________________
A. Educational Data
List in chronological order every college or university you have attended and/or attending, beginning with the most recent College University City/State Dates Attend(ing) Degrees Received
All applicants for admission to the University must have the Registrar of each college/university attended send official transcripts of their work to the Office of Graduate Studies and Research.
For which degree/certificate are you applying? ____________________________________________________

Have you taken the GRE/GMAT? Yes____ No____ Were your scores sent directly to TAMUCC? Yes____ No____ Quantitative__________ Analytical__________ Test Date________________
GRE scores: Verbal_________ GMAT total score:__________
Test Date________________ No________ (TAMUCC requires a
Have you taken the Test of English as a Foreign Language (TOEFL) ) yes________ TOEFL score of 550 or higher or an IBT of 79-80 or higher for graduate students )
Has your official TOEFL/IBT score been sent to TAMUCC? Yes____ No____ Score________ Test Date______
B. Certification
I understand that the information submitted herein will be relied upon by officials of Texas A&M University-Corpus Christi to determine my status for admission and residency for tuition purposes. I certify that the information on this application is accurate and complete and understand that the submission of false information is grounds for rejection of my application, withdrawal of any offer of acceptance, cancellation of enrollment, or appropriate disciplinary action.
THIS APPLICATION IS NOT COMPLETE AND WILL NOT BE ACCEPTED WITHOUT YOUR SIGNATURE.
Signature ________________________________________________
Date ____________________
Notification of Acceptance: The individual graduate program will notify applicants of its decision. With respect to admission and education of students, Texas A&M University-Corpus Christi shall not discriminate either in favor or against any person on the basis of race, creed, color, sex, age, national origin or disability.
Dr. William J. Paver, Director 1910 Justin Lane Austin, TX 78757-2411
APPLICATION
1. GENERAL INFORMATION
FOR
CR EDENTIALS E VALUATION
phone 512.459.8428 fax 512.459.4565 email: info@fcsa.biz www.fcsa.biz
PRINT your full legal name, without abbreviation First name Middle or other name Family name Email address Phone number(s)
Print other family name that might appear on documents Address 1: complete this box if you want both copies sent to address 1 ESLI 4528 Humphrey Hill Road Sedro Woolley, WA 98284 Phone Number: 360-724-0547 Fax Number : 360-724-0548
Do you want your copies sent in separate sealed envelopes? q Yes
Fax number q No Birth date (MM/DD/YY) Country of origin Gender q Male
Address 2: complete this box if you want one copy sent to address 1 and the other sent to address 2
q Female
2. SERVICES AND FEES
BASE FEES (choose one only) 2 copies will be prepared. A non-refundable processing fee of $25 is included in the base fee. Evaluations will be completed and mailed within about 2 weeks after all documents are received unless a rush service is selected below.
q General Statement of Equivalency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $75 (US) . . . . . . . . . . . . . . _______

Describes foreign academic documents, degrees, certificates, and diplomas in US educational terms. n Detailed Evaluation of Coursework . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $110 (US) . . . . . . . . . . . . .$110.00 . _______ Includes the General Statement of Equivalency and provides a detailed course-by-course listing which can be used to award transfer credit for universities, professional licensing agencies, teacher certification, etc.
OPTIONAL FEES q One Day Service - General Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $175 (US) . . above base fee . _______ q One Day Service - Detailed Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $210 (US) . . above base fee . . _______
One day evaluations are completed within 24 hours AFTER the receipt of the FCSA application, fees, and necessary educational documents, translations, etc. The evaluation will be returned by regular first-class mail unless overnight delivery is requested and paid.
q Rush Service (3 working days after receipt of ALL materials) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $75 (US) . . above base fee . . _______
Rush evaluations are completed in 3 working days AFTER the receipt of the FCSA application, fees, and necessary educational documents, translations, etc. The evaluation will be returned by regular first-class mail unless overnight delivery is requested and paid.
q U.S. Overnight Delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $25 (US) . . per address . . . _______ q Foreign Overnight Delivery (subject to carrier restrictions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $35 (US) . . per address . . . _______ q ABET Evaluation (add to detailed evaluation base fee if you qualify) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $85 (US) . . . . . . . . . . . . . . _______
Please contact TBPE (512-440-7723) to see if you need an ABET evaluation.
q Additional copies (FCSA basic service includes two copies of your evaluation) . . . . . . . . . . . . . . . . . . . . . . . . $25 (US) . . per addl copy . . _______
Copies of your evaluation are available for two years after the exact original date of your evaluation. If you need the additional copies mailed to more than the two addresses alloted above, write them in Section 8 of this application.
q Revisions (changing or adding to your original evaluation) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $50 (US) . . . . . . . . . . . . . . _______

Revisions can be done for two years after the exact original date of your evaluation. Send a photocopy of your evaluation along with photocopies of additional documents to be evaluated. If two years or more have passed since the date of your original evaluation, you will need to start a new evaluation. Base fee plus optional fee = TOTAL . . . . . . . . . ._______
Important note: FCSA will keep your completed evaluation on file in our office for exactly two (2) years from the completion date at the top of your evaluation. After that date, copies will not be available and you will need to reapply and resubmit the entire application package, including the full fee.
3. SUMMARY OF EDUCATIONAL EXPERIENCE Beginning with the 10th year of formal education, complete the following educational ladder: (Include any school you are presently attending. Use additional sheet if necessary.) Name of school and location Years of attendance month/year month/year Degree, title, or certificate Year earned or expected
_______________________________________________ __________ to __________ ________________________________ __________________ _______________________________________________ __________ to __________ ________________________________ __________________ _______________________________________________ __________ to __________ ________________________________ __________________ _______________________________________________ __________ to __________ ________________________________ __________________ _______________________________________________ __________ to __________ ________________________________ __________________ _______________________________________________ __________ to __________ ________________________________ __________________ _______________________________________________ __________ to __________ ________________________________ __________________ 4. PAYMENT Please enter amount from TOTAL line at the end of section 2: __________________ From WITHIN the United States: q I am enclosing my check drawn on a US bank, money order, or cashiers check made payable to FCSA. From OUTSIDE the United States: q I am enclosing my international money order or check drawn on a US bank made payable to FCSA. 5. REFERRAL INFORMATION Please tell us who referred you and the purpose of your evaluation. Check as many from the list at right that apply.
ESLI _________________________________________________ Name of referring party

q n q q q q
Employment/H1 Visa TAMUCC University admission: University ____________________ Teacher certification: State ________________________ Board or agency: Name __________________________ Immigration Other ________________________________________
From either within or outside the United States: q Please bill my credit card: q VISA q MasterCard
q American Express
Name on card: _______________________________________________________ Credit card #: ___________________________________ Exp. date: ______/______ 6. WHAT TO SUBMIT
1. REQUIRED DOCUMENTS, STANDARD APPLICATION FCSA requires that most clients submit LEGIBLE PHOTOCOPIES of all original educational documents: final degrees, diplomas, and certificates plus full transcripts/marksheets/academic records showing all subjects studied, examinations, and grades. A standard FCSA requires the following: q Legible photocopies of ALL necessary academic documents. q Certified English language translations, if necessary. Spanish may be self-translated. q Appropriate payment. q Signature at the bottom of this form. 2. REQUIRED DOCUMENTS, EVALUATION FOR BOARD LICENSURE Clients submitting evaluations to licensure boards need to visit our website (www.fcsa.biz/board) for more detailed instructions and contact the board directly. Many boards require that you submit academic documents sent in a sealed envelope from the institution of origin. You can also get information on board applications by emailing info@fcsa.biz or calling 512-459-8428. If you are applying for board licensure, it is essential that you contact the board as well as making an application to FCSA. 3. TRANSLATIONS Certified word-for-word English translations must accompany all foreign language documents. If your document is in Spanish, you or a friend or family member may translate it. 7. COMMENTS Use this space to provide FCSA with additional information that could be useful in your credentials evaluation. __________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________ 8. SIGNED STATEMENT I certify that all information provided in this application is complete, factually accurate, and honestly presented. I certify that I have read the instructions and conditions and agree to the terms stated therein. I understand that the evaluation is advisory and is not binding upon any agency or institution that uses it. I release Foreign Credentials Service of America from any liability for damages resulting from the use to which I or any agency or institution puts the evaluation. Signature of Application _________________________________________________________________ Date _________________________________
Texas A&M University - Corpus Christi

Sponsors Financial Guarantee
Name of Student: _________________________ (Family Name)
___________________________ (Given Name)
Date of Birth of Student: (Month/Date/Year): _________________________________ I certify that I am financially able and willing to support the above mentioned student while he/she is pursuing a course of study at Texas A&M University - Corpus Christi. I hereby guarantee to provide sufficient funds to pay for the tuition, fees, medical insurance, living and personal expenses of the student while studying at Texas A&M University - Corpus Christi.
Signature of Sponsor: __________________________________________________ Relationship to Student:_________________________________________________ Date: __________________________________________________
_________family members will accompany student
Name
Relationship
Date of Birth
Country of Birth
An additional US$2,400 per month for each dependant will be required in financial support documents. An original bank letter or statement of account must be attached to this form providing evidence of funds available to meet the expenses of the student.
*** Transfer Report Form for F-1 Students ***

SEVIS SCHOOL CODE: SNA214F05240000
Instructions for F-1 Students: If you are transferring to Texas A&M University-Corpus Christi from another U.S. institution, you must complete this form in its entirety. NOTE: Students who enter the U.S. on an A&M-Corpus Christi I-20 do not need to submit this form. SECTION 1: TO BE COMPLETED BY STUDENT I hereby authorize you to submit the information requested below (in Section 2) to the Office of Admissions at Texas A&M University-Corpus Christi. Students name (please print): ____________________________________________________________
Last (Family) First Middle
Signature:___________________________________________________________ Date:___________ SECTION 2: TO BE COMPLETED BY AN INTERNATIONAL STUDENT ADVISOR To the best of your knowledge, is the student noted above currently in legal F-1 status and eligible to transfer to Texas A&M University-Corpus Christi?
Yes
Is the student eligible to return to your institution?
No Yes No No
If no, please explain: ___________________________________________________________________
What term did the student last complete at your institution? ____________________________________ What is the completion date on the students current I-20? _____________________________________ Is the student registered in SEVIS?
Yes
SEVIS ID No.:_________________________
Anticipated SEVIS transfer release date: ________________________ Please list any dates granted for full-time curricular practical training or optional practical training: ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ Name (please print):______________________________________ Title: ___________________________ Signature: _____________________________________________________ Date: _________________ Institution name: ________________________________________ Phone: _______________________ Once completed, please submit this form to:
Texas A&M University-Corpus Christi Coordinator, International Student Services Office of Admissions & Records 6300 Ocean Drive, Unit 5774 Corpus Christi, TX 78412-5774 Or fax to: 361.825.5887
On-campus housing application at TAMUCC

Date: / / Name: Social Security #: TAMU-CC Banner ID#: A Address: City: Email: Current telephone: ( ) Cellular telephone: ( ) Drivers license #: University standing: freshman senior Participant in any University Programs: Have you ever been convicted of a felony? Parent/guardian: Address: City: Telephone: ( ) Email: Other emergency contact: Relationship: Telephone: ( )
ESLI STUDENT
Gender: male female Date of Birth: / /
State:
Zip:
sophomore graduate yes no
State: junior faculty/staff
State:
Zip:
I wish to reside in the following accommodation: (list 1,2,3, etc. in order of preference in the boxes below) Please select only those options to which you are willing to accept assignment. residence hall 2 bdrm non-private / shared bath (1R) residence hall 1 bdrm / suite bath (limited summer availability) (2R) residence hall 1 bdrm / private bath (limited summer availability) (3R) apartment - 1 bdrm / 1 bath studio single occupancy (1A) apartment - 1 bdrm / 1 bath shared bedroom (2A) apartment - 2 bdrm / 1 bath private bedroom (3A) apartment - 4 bdrm / 2 bath private bedroom (4A) i am requesting to be placed in Honors Housing* * assignment made based on space available and certification of program acceptance. i am requesting to reside in substance free housing^ ^ available only in select units (Residence Hall Suite, 4 bedroom and 2 bedroom style). I am requesting the following lease term, beginning year A Rate B Rate august august june august august may january august january may Roommate(s) preference (Name, & Banner ID) 2: ID# 1: 3: :
ID# ID#
(In order for roommate requests to be considered, the requests must be mutual. Requests do not guarantee a match.)
Page 1 of 4
Application 08-09Application 08-09

Personal habits: yes I object to late night activity (after 11pm) Loud noise disturbs me I want to have guests visit I am ok sharing my stuff with my roommate I want to get involved with the community Do you smoke?* *smoking is not allowed in any Camden Miramar building. Are you? neat casual messy Describe any special accommodations needed: no no preference
Rental application criteria: All applicants must complete the on-campus housing application In order to reside in our community, we require each applicant to meet certain rental criteria. Before you complete an On-Campus Housing Application, we encourage you to review these requirements to determine if you are eligible. Please note that these are our current rental criteria and nothing in these requirements shall constitute a guarantee or representation by our community that all residents currently residing in our community have met these requirements. There may be residents that have resided here prior to these requirements going into effect; therefore, existing residents met the qualifications required at the time they were approved. A. ON-CAMPUS HOUSING APPLICATION Applicants must submit an on-campus housing application and pay a $200 nonrefundable administrative fee which will become nonrefundable and applied towards the Administrative Fee due under applicants lease if applicants application is accepted. Applicant acknowledges that the Administrative Fee is: (i) not a security deposit or an advance payment of rent or any other fees or charges; and (ii) an estimated amount calculated to offset the actual and potential costs of the Owner for application processing and database management. All information requested on the on-campus housing application must be complete. Failure to provide such requested information may delay assignment process or invalidate the oncampus housing application. Roommate requests must include requested roommate(s) name and social security or Banner ID number. LEASE GUARANTY - (1) Applicants must submit a Lease Guaranty form with On-Campus Housing application. (2) Lease Guarantor must be a parent, guardian or approved consenting adult. (3) Lease Guaranty form must be accompanied by a copy of the drivers license of the Lease Guarantor. (4) In lieu of Lease Guarantor, applicant must submit an application deposit (which will be used as a security deposit when applicant signs a lease. AMENITY FEE - Applicant will be required no later than the time of lease execution, to make payment of an Amenity Fee. The Amenity Fee will be a one time fee during the term of the Lease to offset the Owners costs associated with providing laundry services which are available to residents. The amount of the Amenity Fee will be in accordance with the following schedule: (i) if the lease term is from August through May (being both Fall and Spring semesters), the Amenity Fee will be $108.00; (ii) if the lease term is from August to August a(for a full year), the Amenity Fee is be $138.00; (iii) if the lease term is from January through May (the Spring semester), the Amenity Fee will be $54.00; (iv) if the lease term is from January through August (the Spring semester and the Summer term), the Amenity Fee will be $84.00; and (v) if the lease term is from June through August (the Summer term), the Amenity Fee will be $30.00. UNIVERSITY ADMITTANCE Applicants must be admitted to Texas A&M University Corpus Christi prior to eligibility for assignment. Residents must be enrolled and taking classes
B.
C.
D.
Page 2 of 4

during the fall or spring semesters. Summer residents are not required to be admitted nor enrolled in summer semester classes.
E.
FALSE INFORMATION - Any falsification of information on the application will automatically disqualify the application and all deposits, administrative fees and prepayment monies will be forfeited, per the cancellation policy. HOUSING PAYMENT OPTION FORM If the applicant is utilizing financial assistance to cover housing costs, the applicant must submit a completed Housing Payment Option Form to the Camden Miramar office. Housing Payment Option Form will not be accepted after the deadline stated on form. Additionally, please note that no deferment of the Confirmation Prepayment or waiver of applicable late fees shall be granted except by specific written authorization of Camden Miramar Management. CANCELLATION OF APPLICATION If the applicant finds it necessary to cancel their application for residency, the confirmation prepayment will be refunded provided that written cancellation is submitted to Camden Miramar at least 60 days prior to move-in. Within 60 days of move-in, $100 of the confirmation prepayment will be refundable with written notice of cancellation provided: (1) The applicant has not signed a Camden Miramar Lease Contract and Community Policies and; (2) Camden Miramar has not initiated notification to the applicant of assignment to a guaranteed permanent assignment. CRIMINAL HISTORY- Applicant must not have been convicted or received deferred adjudication for any felony offense, a sex-related offense, a class A misdemeanor offense classified as an offense against a person or any drug-related offense (felony or misdemeanor). Please remember that this requirement does not constitute a guarantee or representation that residents currently residing in our community have not been convicted of a felony, deferred adjudication for a felony or crime against a person. APPLICATION ASSIGNMENT PROCESS Applicants are assigned a bed at Camden Miramar. Apartment assignments will be assigned an individual bedroom within an apartment area. The common areas (including living room, kitchen, bathroom, outside patio and outside storage) of the apartment will be shared by assigned roommates. Residence Hall assignments will be assigned a bedroom area. The common area, bathroom, will be shared by an assigned suitemate. Camden Miramar reserves the right to change assignments at any time. ASSIGNMENT PACKET Once an applicant has been accepted and a space assignment has been made, the applicant will be mailed an assignment packet. Included in the assignment packet will be the Camden Miramar Lease Contract and Community Policies and other informative documents. Applicant will be required to initial, sign and return the Camden Miramar Lease Contract and Community Policies within 5 business days after receipt of the Assignment Packet. If the Camden Miramar Lease Contract and Community Policies are not returned within 15 business days after delivery, the assignment may be subject to cancellation upon us giving applicant written notice at any time prior to receipt of the executed Camden Miramar Lease and Community Policies. Due to time restrictions, assignments made within 21 days prior to move in will not have an Assignment Packet mailed. These applicants are required to pick up the Assignment Packet, once available, prior to move in at the Camden Miramar office. If applicant is not able to pick up the Assignment Packet prior to move in, it may be completed at check in. Provided, however, no applicant will be allowed to move into our community unless and until all required documents (including the Camden Miramar Lease, the Community Policies, the Lease Guaranty and any other required documents) are fully executed by the appropriate parties.
F.
G.
G.
Page 3 of 4

J CONFIRMATION PREPAYMENT In the event that applicant has been accepted and guaranteed a bed (identified as an assigned space) at Camden Miramar, applicant agrees to pay a $200 confirmation prepayment upon the later of: (I) the date of this application; or (ii) the date that is 60 days prior to the beginning date of the term of the Lease Contract. The confirmation prepayment will be applied to rent at the time applicant moves into an assigned space. If applicant fails to pay the confirmation prepayment when due or fails to move into an assigned space as prescribed by the lease, applicant will be deemed to be in violation of the lease and Camden Miramar shall have the right, but not the obligation, to pursue all rights and remedies under the lease and applicable law including terminating applicants right to occupancy. Additionally, if applicant pays the confirmation prepayment but fails to move into an assigned space as prescribed by the lease, Owner shall have the right to retain $100 of the confirmation payment as liquidated damages associated with applicants default of this application and the lease. The parties agree that the amount forfeited by applicant is a liquidated amount covering only part of the Owners damages in connection with the Owners time, effort and expense resulting from applicants failure to move into an assigned space as required by the lease.
This company and this community comply with all applicable fair housing laws. The undersigned applicant(s) hereby consent to allow Camden Miramar, itself or through its designated agents and its employees, to obtain a consumer report and criminal record information on me and to obtain and verify my credit and employment information for the purpose of determining whether to lease an apartment to me. I also agree and understand that owner and its agents and employees may obtain additional consumer reports and criminal record reports on me in the future to update or review my account. Upon my request, owner will tell me whether consumer reports or criminal record reports were requested and the names and addresses of any consumer reporting agency that provided such reports. Payments due: At time of application $200 Administration fee. 60 days prior to move-in $200 Confirmation prepayment. (if applying within 60 days of move-in administration fee and prepayment are due at time of application) By signing this application, applicant acknowledges that applicant has had the opportunity to review the Owners resident selection criteria. The resident selection criteria may include factors such as criminal history, credit history, current income and rental history. If applicant does not meet the selection criteria, or if applicant provides inaccurate or incomplete information, this application may be rejected and applicants application fee will not be refunded. I have completed the on-campus housing application and read and understand the Rental Application Criteria.
Applicant Date
Camden Representative Date
instructions: Please return a completed on-campus housing application and rental criteria along with requisite deposits, fees and prepayments to Camden Miramar, 6515 Ocean Dr, Corpus Christi, TX 78412. We encourage you to keep a copy of the on-campus housing application and rental application criteria for your records.
Page 4 of 4
LEASE GUARANTY
This Lease Guaranty (this Guaranty) is made and entered into by the undersigned (the Guarantor) in favor of Camden Property Trust d/b/a Camden Miramar (the Owner) upon the terms and conditions stated herein. The purpose of this Guaranty is to express the terms upon which Guarantor will guarantee certain obligations of (print applicants name)________________________________________(the Resident) under the Lease Contract (the Lease) dated ___________________ whereby Resident has leased an Apartment (the Premises) in Owners apartment community. For and in consideration of the mutual promises contained herein and in the Lease and for other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, Guarantor agrees as follows: 1. Guarantors Representations. Guarantor represents that: (i) Guarantor has reviewed the Lease and any addenda thereto or documents to the extent Guarantor deems appropriate and understands that Owner's desire to enter into the Lease with Resident is expressly made conditional upon Guarantor's execution of this Guaranty; and (ii) that all information submitted in Resident's Rental Application and provided below was and is true and complete and authorizes the verification of same and the performance of a credit check on Guarantor by any means. Guarantor acknowledges that false information contained in Resident's Rental Application may constitute grounds for rejection of Resident's Rental Application, termination of Resident's right of occupancy and non-return of deposits. Guarantor further acknowledges that an investigative consumer report including information as to character, general reputation, personal characteristics and mode of living, whichever are applicable, of the Guarantor may be made and that any person on which an investigative consumer report will be made has the right to request a complete and accurate disclosure of the nature and scope of the investigation requested and also has the right to request a written summary of the person's rights under The Fair Credit Reporting Act. GUARANTOR HEREBY AUTHORIZES OWNER OR OWNERS AGENTS TO OBTAIN AND HEREBY INSTRUCTS ANY CONSUMER REPORTING AGENCY DESIGNATED BY OWNER OR OWNER'S AGENTS TO FURNISH A CONSUMER REPORT UNDER THE FAIR CREDIT REPORTING ACT TO OWNER OR OWNERS AGENTS TO USE SUCH CONSUMER REPORT IN ATTEMPTING TO COLLECT ANY AMOUNTS DUE AND OWING UNDER THE LEASE OR THE GUARANTY OR FOR ANY OTHER PERMISSIBLE PURPOSE. 2. Guaranty of Obligations. Guarantor hereby individually and unconditionally guarantees to Owner the full, punctual and complete performance by Resident of all obligations of Resident to Owner including, but not limited to, obligations contained in the Lease, extensions or renewals of the Lease, when Resident transfers to a different apartment unit within the Owners apartment community or when rent or other charges are increased in accordance with or after the stated term of the Lease. Guarantor agrees that Guarantor shall be personally bound by and personally liable for all obligations of Resident as if Guarantor executed the Lease or other documents giving rise to Residents obligations. In the event Resident fails to comply with any obligations under the Lease or such other documents or in the event the Lease is declared invalid or void as a result of Residents age or otherwise, Owner may recover any damages or other charges including, but not limited to, rent, late charges, property damage, repair costs, utility payments and all other sums which may become due under the Lease from Guarantor, as if Guarantor executed the Lease as Resident, whether or not Owner seeks recovery from Resident. Guarantor waives: (i) any right to require Owner to proceed against Resident; (ii) any defense by reason of any disability of Resident or any other defense based on the termination of Residents liability for any reason; (iii) any right to presentment, demand for performance, notices including notices of nonperformance, protest, dishonor, acceptance of this Guaranty or the existence, creation or renewal of any obligations; and (iv) any benefit of any statute of limitations affecting Guarantors liability under this Guaranty. Notwithstanding Guarantor's guarantee of the obligations of Resident as described herein, Guarantor expressly recognizes that Guarantor shall have no right to possession of the Premises identified in the Lease or any other apartment unit in the Owners apartment community and that this Guaranty creates no obligation on Owner to provide any benefits whatsoever to Guarantor. Owner may report unpaid rent, damages or other charges owed by Resident (and consequently by Guarantor) to the applicable credit reporting agencies for recordation on Guarantors credit record.
412145v1
HMB
DATE
Lease Guaranty
3. Notice. Guarantor acknowledges that Owner shall have no obligation to provide Guarantor with any type of notice of default or any notice whatsoever as a prerequisite or condition to Guarantor's liability after an event of default by Resident under the Lease or such other document giving rise to Residents obligations.
Additionally, Guarantor acknowledges that Owner shall have the right to terminate the Lease or such other document or terminate Resident's right to possession without terminating the Lease or such other document pursuant to the terms of the Lease, such other document and applicable law after an event of default by Resident without the necessity of providing Guarantor with any notice. Guarantor expressly waives the right to receive any such notice from Owner. Notwithstanding the foregoing, Owner shall have the right, without the obligation, to provide notice to Guarantor with respect to any event of default either at the address of the Premises or the address identified below, which is Guarantor's permanent mailing address: EXECUTED as of the date of the Lease.
Guarantors Name: Relationship to Lease holder: Address: City/State/Zip: E-mail address: Home Phone: Social Security Number: Drivers License Number: Date of Birth: Signed: Signature of Guarantor (not the Resident) Cell Phone:
Gender: male / female
State:
This form requires a copy of Guarantors Drivers License or government photo I.D. be attached to be valid.
412145v1
HMB
DATE
Lease Guaranty
Date of TAMUCC Enrollment____ ____ ____

mo day yr
TAMUCC Student Immunization Form

Texas A&M University - Corpus Christi policy require students to document immunizations in English for the following diseases. If you intend to enroll at the University, please complete and return this form to TAMUCC ESLI prior to the start of your first semester. Call 361-825-3435 if you have questions. Name _________________________________________________University ID No. ________________________
Last First Middle
Permanent Address _____________________________________ Phone __________________________________ City__________________________________ State ______ Zip __________ Date of Birth______________________
Month Day Year
Note: MMR vaccine is recommended to provide protection against measles, mumps and rubella
Rubeola: (ten day measles): Must have the following:

Two immunizations required at least thirty days apart (after 1967 & not before first birthday) 1st immunization .........................................................month/day/year received _____/_____/_____ 2nd immunization.........................................................month/day/year received _____/_____/_____ Or measles titer............................................................month/day/year tested _____/_____/_____ Results_________ Or physician-diagnosed measles disease............................month/day/year diagnosed _____/_____/_____ Vaccine not required if born before January 1, 1957_____ (Please check only if applicable)
Mumps: Must have one of the following:

One immunization (not before first birthday).................month/day/year received _____/_____/_____ Or mumps titer.............................................................. month/day/year tested _____/_____/_____ Results_________ Or physician-diagnosed mumps disease.............................month/day/year diagnosed _____/_____/_____ Vaccine not required if born before January 1, 1957_____ (Please check only if applicable)
Rubella: (German/three day measles): Must have one of the following:

One immunization (not before first birthday).................month/day/year received _____/_____/_____ Or rubella titer ...............................................................month/day/year tested _____/_____/_____ Results ________ Physician-diagnosis rubella disease not acceptable. Vaccine not required if born before January 1, 1957_____ (Please check only if applicable)
Tetanus/Diptheria: TD booster within last 10 years required (Tetanus alone not acceptable)
Immunization.....................................................................month/day/year _____/_____/_____
Tuberculin Skin Test (TB)(Mantoux only): Administered at TAMUCC for International Students
Date given_____/_____/_____ Date Read_____/_____/_____ Results_______ mm duration Signature of physician or registered nurse reading test _______________________________________________ Chest x-ray required if reading 10mm or greater: Date of chest x-ray__________ Results_______
Meningococcal Conjugate (MCV4) (Meningitis) REQUIRED at least 10 days prior to moving on campus
One immunization.................month/day/year received _____/_____/_____
Physicians Signature: Note: If not signed by a physician/registered nurse, you must provide proof of documentation
Name (print): ____________________________________________ Signature: ______________________________ Address: ______________________________________________________________________________________________
Phone: ______________________________________________FAX: _____________________________________
Over - Medical Contraindication Statement
Medical Contraindication Statement

The individual identified on this form has been diagnosed with a medical condition which precludes receiving the following vaccines: Vaccine Medical Contraindication* of Vaccine Probable Duration of Contraindication
It is understood that in the event the disease (except tetanus) for which this exemption requested occurs on campus, the individual will be excluded from all campus activities until Public Health Authorities declare the threat of disease has ended. This action will be taken to prevent the spread of disease to the individual who cannot medically receive the vaccine.
Note: Name, address, phone and signature of physician or clinic required to validate medical contraindication:
Name ______________________________________________________________________________________________ Address ______________________________________________________________________________________________ ______________________________________________________________________________________________ Phone ________________________________________________FAX___________________________________________ Signature ______________________________________________________________________________________ * Medical Contraindication to Vaccine must be in accordance with recommendations of Advisory Committee on Immunization Practices listed below: General Contraindications
1. Anaphylactic reaction to a vaccine contraindicates future doses of the vaccine 2. Anaphylactic reaction to a vaccine substance contraindicates the use of vaccines containing that substance
Contraindications to MMR
1. Anaphylactic reaction to eggs or neomycin* 2. Pregnancy 3. Known altered immunodeficiency (hematologic and solid tumors, congenital immunodeficiency, or long term immunosuppressive therapy) 4. Measles vaccine should not be given for at least six weeks (preferably three months) after a person has received IG, whole blood, or other antibody containing products
Contraindications to TB (Mantoux) skin test

1. Students having recent viral infections or live virus vaccines (i.e. MMR). To obtain an accurate result when infection is strongly suspected, it is best to repeat testing several weeks after the illness, and 4-6 weeks after administration of the vaccine. 2. Past documented history of positive Mantoux. Chest x-ray required. * Vaccinate only with extreme caution. Consult protocols for vaccinating such persons (J Pediatrics l983; 102:196-9 and JPediatrics STL96K0083 1988; 113:504-6)
Texas A&M University-Corpus Christi University Health Center
Consent For Treatment

Date__________________________________ 1. I, (Name of person giving consent) , (the)________________________________ ( relationship to patient) __________________________ SS or Student ID # of Patient
of ____________________________________ Name of Patient
hereby voluntarily consent to outpatient care encompassing routine diagnostic procedures, examinations, and medical treatment. This may include (but is not limited to) routine laboratory work, x-rays, administration of medications, inpatient and emergency care as needed. 2. I further consent to the performance of those diagnostic procedures, examinations, and the rendering of medical treatment by the office staff and their assistance as directed by the provider. 3. I authorize Student Medical Services to release medical information to third party insurance carriers for the purposes of filing insurance claims related to his/her medical care if applicable. I authorize Student Medical services to release any medical information to other physicians or medical providers as directed by the Student Medical Services Department. I authorize the release of medical information about his/her treatment to any other physician, provider or facility designated by me. 4. I understand that this consent form will remain in effect as long as the patient is a minor. 5 This form has been fully explained to me and I understand its contents. Patient is a Minor years of age. Date of birth_______________
______________________________________ Signature of Legal Guardian
______________________________ Witness
USA
CANADA
TEL: 360-724-0547 FAX: 360-724-0548

NAME OF STUDENT: __________________________________________________
University of Southern Indiana

STUDENT NAME:______________________________

UNDERGRADUATE & ENGLISH______ GRADUATE & ENGLISH______ START DATE FOR ENGLISH____________ MAJOR AREA OF STUDY______________ This application package must include the following items: 1. 4 Page International Student Application for Admission Form 2. US$140 Application/Courier fees payable to ESLI 3. Official Original Certified original school transcripts 4. Official Original Certified School graduation diploma 5. Intl Student Official Statement of Finances signed by sponsor 6. Original Sponsors Bank letter showing balance available 7. 2 letters of recommendation (optional) 8. Study plan 9. Copy of Passport 10 ECE Application form and $210 fee for Official Detailed Evaluation of Coursework for ALL Masters level applicants & Bachelor level applicants with prior college or university credits. 11 Residence Life/Food Service Contract form
ENGLISH ONLY
USI/ESLI ONLY______ START DATE____________ ENDING DATE___________ This application package must include the following items: 1. 4 Page International Student Application for Admission Form 2. US$140 application & Courier fees payable to ESLI 3. Intl Student Official Statement of Finances signed by sponsor 4. Original Sponsors Bank letter showing balance available 5 Copy of Passport AGENCY: ______________________________ COUNSELOR:___________________________ ADDRESS:______________________________ ________________________________________ CITY:______________COUNTRY:___________ TEL:_______________ FAX:________________ EMAIL:_________________________________
Mailing Address:
ESLI 4528 Humphrey Hill Road Sedro Woolley, WA 98284 USA Tel: 360-724-0547 Fax: 360-724-0548 Email: esli@esli-intl.com Website: www.esli-intl.com
International Student Application For Admission

Office of Admission
8600 University Boulevard Evansville, Indiana 47712-3598 U.S.A.
Please send completed application with application fee and supporting forms and documents to: ESLI 4528 Humphrey Hill Road Sedro Woolley, WA 98284
Biographical Information (Please print in ink or type.) To be completed by a student who is not a permanent resident or citizen of the U.S.
Name _________________________________________________________________________________________________ _______ _________ __________
last first middle preferred name U.S. Social Security No. (If available)
Home address ________________________________________________________________________________________________________________________

number and street city state/province/county ZIP or postal code
______________________________________________________________________ Telephone _____________________________________________________

country country code/city code/telephone number
Fax number_____________________________________________________ Electronic mail address__________________________________________________

country code/city code/fax number
Use mailing address until _______________________________________________ Birthdate __________________________ Country of birth ____________________
date month/day/year
Country of citizenship _______________________________________________________________________ Permanent resident (U.S.)? Visa type (if currently in the U.S.): Male Female Student (F) Marital Status: Single Exchange Visitor (J) Married
Yes
No
Other_________________ Are you a Resident of Indiana? Yes No
Application Information
Applying for Admission as: Beginning Freshman (never attended a college or university) Transfer (attended one or more colleges or universities) Guest (enrolling for only one semester or two summer sessions as visiting student from another college/university) Exchange (please list exchange program) : _______________________________________________________________ ___________________________________________________________________________________________________ I plan to enter USI: (check one) Fall Semester, 20 ___ (deadline - May 1) Spring Semester, 20 ___ (deadline - October 1) What will your classification be when you enter USI? 1st Semester Freshman (1 - 15 semester hours) 2nd Semester Freshman (16 - 31 semester hours) 1st Semester Sophomore (32 - 46 semester hours) 2nd Semester Sophomore (47 - 62 semester hours) 1st Semester Junior (63 - 77 semester hours) Indicate Academic School of your area of study. Nursing & Health Professions Business Education & Human Services Degree sought
Summer Session I, 20 ___ (deadline - March 1) Summer Session II, 20 ___ (deadline - April 1) Summer Session III, 20___ (deadline - May 1) 2nd Semester Junior (78 - 93 semester hours) 1st Semester Senior (94 - 108 semester hours) 2nd Semester Senior (109 and above semester hours) Entering with undergraduate degree Exchange student:_____________________________________________
program
Science & Engineering Liberal Arts University Division (undecided) Associate Yes Bachelors No None
Area of Study/Major*_________________________________________________
Do you plan to teach?*
*If you plan to major in secondary education, please name a specific area of study.______________________________________________________________
Academic Information
School you attend now_________________________________________________ Date of entry____________________________________________________ Address______________________________________________________________ Date of secondary school graduation_____________________________________ The name of the person at your school assisting you with your university search: Name________________________________________________________________ School telephone______________________________________________________
country code/city code/telephone number
ACT/CEEB code number (if available or known)______________________
Position________________________________________________________ School fax______________________________________________________

Electronic mail address of school_________________________________________________________________________________________________________ List all other (pre-university) schools you have attended, beginning with your 13th year of age. ______________________________________________________________________________________________________________________________________
name of school name of school name of school location location location dates of attendance dates of attendance dates of attendance certificates, degrees, diplomas certificates, degrees, diplomas certificates, degrees, diplomas
______________________________________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________________________ In your current school, are you pursuing any of the following programs? GCE A Levels International Baccalaureate GCE O Levels French BAC
German Abitur Other national exam program____________________
List all institutions you have attended at the university level. (Failure to list all institutions could result in dismissal.) ______________________________________________________________________________________________________________________________________
name of institution name of institution name of institution name of institution location location location location dates of attendance dates of attendance dates of attendance dates of attendance certificates, degrees, diplomas certificates, degrees, diplomas certificates, degrees, diplomas certificates, degrees, diplomas dates received dates received dates received dates received
______________________________________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________________________ Have you ever been dismissed from any high school, college, or university? Yes No
If so, why?________________________________________________________________________________________________________________ If not currently attending school, please check here: On a separate sheet, describe in detail your activities since last enrolled.
Language Skills/Test Results

First language, if other than English:_______________________________________________ Language spoken at home:________________________________ The TOEFL (Test of English as a Foreign Language) or other comparable proof of English proficiency is required if English is not your first language or language of instruction. The SAT I (Scholastic Assessment Test) or ACT (American College Test) is required if English is your first language or language of instruction. Please submit official score reports. TOEFL* ___________________________________
date taken/to be taken
Paper Test Computer Test ___________________________

___________________________
testing location
__________________
composite score
Other English Language Proficiency test result(s) _____________________________________

test name
____________________________
testing location
__________________
score(s)
_____________________________________
test name
___________________________
____________________________
testing location
__________________
score(s)
SAT I*
_____________________________________
___________________________
verbal score
____________________________
math score
_____________________________________
___________________________
verbal score
____________________________
math score
ACT*
_____________________________________
___________________________
composite score
____________________________
_________________
composite score
* The SAT and TOEFL code for USI is 1335. The ACT code is 012070.
Family and Financial Information

Mothers full name________________________________________________________________ Is she living?__________________________________ Home address if different from yours______________________________________________________________________________________________________ Fathers full name_________________________________________________________________ Is he living?___________________________________
Home address if different from yours______________________________________________________________________________________________________ If not with both parents, with whom do you make your permanent home?______________________________________________________________________ Amount of money available for each year of study (in U.S. dollars):____________________________________________________________________________ Financial Sponsors Name_______________________________________________________________________________________________________________ Financial Sponsors Address______________________________________________________________________________________________________________
number and street country city state/providence/county country code/city code/telephone number ZIP or postal code
_______________________________________________________________ Fax number_____________________________________________________

Telephone___________________________________________________________ Electronic mail address________________________________________________ Children? Yes No
Will you be accompanied in the U.S. by your spouse? Reference to contact in the U.S. (if available):
Yes
No
Name__________________________________________________________ Address________________________________________________________
Relationship__________________________________________________________ Telephone____________________________________________________________
area code/telephone number
CHECKLIST
Your application for admission will not be evaluated until ALL of the following items are on file with the Admission Office: Completed Application for Admission with application fee Scores from the TOEFL SAT Scores - If available Completed financial statement and supporting documentation Complete and attested copies of your academic records (in English) from EACH high school, college, or university you have attended If you will be transferring to USI from another U.S. school or university, you must also submit an International Student Status form.
Additional Information
How did you become interested in USI? ______________________________________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________________________ I hereby affirm all information supplied in this application is complete and accurate. I grant permission for the University of Southern Indiana to report my academic progress to the high school from which I graduated. I understand that withholding information or giving false information will make me ineligible for admission to USI or subject to dismissal after admission has been granted. I also understand that I must enroll as a full-time student (12 hours or more) during the Fall and Spring semesters to maintain my full-time student status. ____________________________________________________________________________
Signature of Applicant
_____________________________
Date
It is the policy of the University of Southern Indiana to be in full compliance with all federal and state non-discrimination and equal opportunity laws, orders, and regulations relating to race, sex, religion, disability, age, sexual orientation, national origin, or status as a disabled veteran or veteran of the Vietnam era. Questions or concerns should be directed to the Affirmative Action Officer, USI Human Resources Department, University of Southern Indiana, 8600 University Boulevard, Evansville, Indiana 47712
The Disabled Student Services program is provided to help students overcome or compensate for obstacles related to a physical, emotional, or learning disability. Resources include a reader/taping service, test accommodations service, tutors, sign language interpreter service, notetaker supplies, literature, and personal assistance. Program staff work with all offices to ensure that reasonable and appropriate accommodations are provided to students with disabilities. A detailed brochure is available from the Counseling Center. Students requesting services must register with the Disabled Student Services program in the Counseling Center at least 60 days prior to date services are needed.
Please mail application to:
ESLI 4528 Humphrey Hill Road Sedro Woolley, WA 98284 U.S.A.
Fax number: 1-360-724-0548 Electronic mail: esli@esli-intl.com
Please note that school records, test scores, and applications are not accepted by fax. (Only under emergency situations and with the approval of the Office of Admission may you fax the application.) Correspondence such as letters and memoranda may be sent by fax.
Fall Spring
Sum.III Sum.l
FOR OFFICE USE ONLY Sum.ll B. Fr Guest HST Tran. Spec.
FOR OFFICE USE ONLY H.S.A. CAP IVTC TCERT International
Res. N.Res
Sr.Gr. Test Sc.
SEA Ao14
Toefl Fee
Core______________ SIS ______________
INTERNATIONAL STUDENT OFFICIAL STATEMENT OF FINANCES

STUDENTS NAME:________________________________________________ It is my understanding that the cost of a college education for one student at the University of Southern Indiana is at least $24,500 (US Dollars) for 2 semesters. This includes tuition, fees, housing/meals, books, and personal expenses. It does not include the cost of transportation to and from the United States, $140.00 application fee or $200 on-campus housing deposit. It is hereby declared that ________________________________US Dollars will be available per academic year for _______________________________as long as he/she is a student in the United Sates, enrolled at the University of Southern Indiana. IMPORTANT: I have attached an official or certified current bank statement showing the balance of my sponsors account (IN US DOLLARS).
_____________________________________________ Signature of financial sponsor SPONSORS PRINTED NAME ____________________________________________ SPONSORS RELATIONSHIP TO STUDENT ________________________________ SPONSORS MAILING ADDRESS _____________________________________ _____________________________________ _____________________________________ Academic scholarships and loans are not available to international students at the University and students may not be able to locate employment on campus. Therefore, USI scholarships, loans or work awards should not be anticipated as supplementing the students means of support.
Send to:
Office of Admission University of Southern Indiana 8600 University Boulevard Evansville, IN 47712-3598 USA
Updated 7/22/09
Date of USI Enrollment____ ____ ____

mo day yr
Student Immunization Form

Indiana State Law and University of Southern Indiana policy require students to document immunizations in English for the following diseases. If you intend to enroll at the University, please complete and return this form to USI Immunization Office prior to the start of your first semester. Call 812-461-5285 if you have questions.
Name _________________________________________________University ID No. ________________________

Last First Middle
Permanent Address ___________________________________________ Phone ____________________________ City_______________________________Country_______________ Zip __________ Date of Birth_______________
Month Day Year
Note: MMR vaccine is recommended to provide protection against measles, mumps and rubella ($55 each at USI)
**Rubeola: (ten day measles): Must have the following:
Two immunizations required at least thirty days apart (after 1967 & not before first birthday) 1st immunization .........................................................month/day/year received _____/_____/_____ 2nd immunization.........................................................month/day/year received _____/_____/_____ Or measles titer............................................................month/day/year tested _____/_____/_____ Results_________ Or physician-diagnosed measles disease............................month/day/year diagnosed _____/_____/_____ Vaccine not required if born before January 1, 1957_____ (Please check only if applicable)
**Mumps: Must have one of the following:
**Rubella: (German/three day measles): Must have one of the following:
**Tetanus/Diptheria: TD booster within last 10 years required
(Tetanus alone not acceptable)
($25 at USI)
Tuberculin Skin Test (TB)(Mantoux only): Must be Administered at USI for International Students ($15)
Date given_____/_____/_____ Date Read_____/_____/_____ Results_______ mm duration physician within 48-72 hours. Signature of physician or registered nurse reading test _______________________________________________ Chest x-ray required if reading 10mm or greater: Date of chest x-ray__________ Results_______
**Physicians Signature: Note: If not signed by a physician/registered nurse, you must provide proof of documentation
Name (print): ____________________________________________ Signature: ______________________________ Address: ______________________________________________________________________________________________ Phone: ______________________________________________FAX: _____________________________________
12/07

1. Anaphylactic reaction to a vaccine contraindicates future doses of the vaccine 2. Anaphylactic reaction to a vaccine substance contraindicates the use of vaccines containing that substance 1. Anaphylactic reaction to eggs or neomycin* 2. Pregnancy 3. Known altered immunodeficiency (hematologic and solid tumors, congenital immunodeficiency, or long term immunosuppressive therapy) 4. Measles vaccine should not be given for at least six weeks (preferably three months) after a person has received IG, whole blood, or other antibody containing products
1. Students having recent viral infections or live virus vaccines (i.e. MMR). To obtain an accurate result when infection is strongly suspected, it is best to repeat testing several weeks after the illness, and 4-6 weeks after administration of the vaccine. 2. Past documented history of positive Mantoux. Chest x-ray required. * Vaccinate only with extreme caution. Consult protocols for vaccinating such persons (J Pediatrics l983; 102:196-9 and J Pediatrics 1988; 113:504-6) STL96K0083
MENINGOCOCCAL AND HEPATITIS B RISK ACKNOWLEDGEMENT

All students entering the University of Southern Indiana for the first time must meet the immunization requirements of the University and Indiana Code 20-1271 enacted by the 2002 Indiana General Assembly. Under these requirements, a postsecondary institution in which an individual intends to enroll shall provide detailed information on the risks associated with Meningococcal and Hepatitis B diseases and the availability and effectiveness of vaccines. I acknowledge that I have read the information provided concerning the risks associated with two communicable, life-threatening diseases, Meningococcal and Hepatitis B. Although these immunizations are not mandatory, I recognize that they are strongly recommended. Signature:____________________________________USI ID#______________ Student at least eighteen (18) years of age Or Signature:________________________________________________________ Parent or guardian, if student is less than eighteen (18) years of age **Please complete this acknowledgement and submit with the enclosed Student Immunization Form to complete your immunization record.**
THIS FORM MUST BE RETURNED

12/07
University of Southern Indiana 20092010 Housing/Food Service Contract

Please type or print clearly. Complete instructions are given in the 20082009 Housing/Food Service Booklet. 1. Contract Period: _____ 20092010 Academic Year (Fall and Spring)
Last First
OFFICE USE ONLY Building: Apt/Room#:
_____ Spring Semester 2010 ONLY

Middle
2. Name: ____________________________________________________________________________________
3. Gender: ____ Male ____ Female
4. Student Identification Number:__________________ 5. Phone (cell) _________________ 6. Phone (home) _________________ 7. Birth date ____________ 8. Permanent address: Street/Box ________________________________________________________________________________________________________ City ____________________________________________________________ State ______________ Zip ____________________ 9. E-mail address: _______________________________________________________________________________________________________________________ 10. Emergency contact person:_________________________________________ Relationship______________________ Phone (home) ____________________
Contact persons address:_____________________________________________________________________ Phone (work) _____________________ Contact persons e-mail address:_______________________________________________________________ Phone (cell) ______________________ 11. Special services needed: _______________________________________________________________________________________________________________
Please explain
12. Your preferences: Keeps room tidy Likes loud music Early riser Goes to bed early
_________Yes _________Yes _________Yes _________Yes
_________No _________No _________No _________No
_________No preference _________No preference _________No preference _________No preference _________Yes _________No
CASHIERS OFFICE USE ONLY Contract and Deposit Received On:
13. I am claimed on my parent(s) 2008 tax statement(s) as a dependent.
14. Living Learning Communities* (For students interested in residence hall living only, see the Housing/Food Services Booklet for more information.): ________Emerging Leaders ________Nursing/Health Professions ________Business ________Elementary Education ________Honors ________Science, Technology, Engineering, Math ________Global Community ________Liberal Arts ________Social Work ________Sophomore Year ________Exploring Majors *For Living Learning Communities, you must fill out the enclosed USI Living Learning Community Application. Send it in with your completed 20092010 Housing/Food Service Contract and deposit. Applications are due by March 1, 2009. For questions 13 and 14, use the table below: 15. Room Selection: Indicate preference by circling and placing a 1 for first preference, and 2 for second preference under the appropriate column to the right of your preferred living arrangement. If your first choice is unavailable, you will be assigned to your second, or next available location. 16. Meal Plan: Indicate your meal plan choice by placing a check next to the meal plan in the Preference column below. If you are placed in the residence hall, you must choose from the Red, White, or Blue plan. If a meal plan is not chosen and you are placed in the residence hall, the White meal plan will be automatically assigned.
ROOM Preferences:
(See Housing/Food Service Booklet)
Rates
per semester
1st
2nd
MEAL Plans:
(See Housing/Food Service Booklet)
Rates
per semester
Preference
Residence Hall Suite 4 person/2 bedroom suite Single bedroom*/1 bedroom (limited availability)
:
Select one: Red Eagle Plan* $1,725 $2,626 White Eagle Plan* Blue Eagle Plan* Titanium Club Plan* $1,725 $3,090 Platinum Club Plan* Gold Club Plan*
$1,625 $1,625 $1,625 $1,089 $799 $570
Campus Apartments Two Bedroom 4 person/2 bedroom Super-Single bedroom**: (limited availability) Campus Apartments One Bedroom 2 person/1 bedroom Super-Single bedroom** (limited availability)
:
$2,084 $3,878
* All meal plans include dinners and lunches in the Loft. See Housing/Food Service Booklet for difference in plans ** Super-Single bedrooms include a double bed and an entertainment center. : Private bathroom
These rates have been set for the 20092010 Academic Year by the USI Board of Trustees. At any time, the Board of Trustees may elect to change the rates. Should a rate change occur, residents will be notified in writing by the University. Changes in Residence Life/food service rates will not be considered grounds for contract termination. 17. Are you transferring from another institution? 18. Roommate preference*: (Do not provide a name.) ______Yes ______No If so, from where are you transferring? _____________________________________ Telephone number ________________________________
Student ID Number_________________________________________ (Student ID number is required.)
*To receive your roommate preference, request must be mutual and be in the same room-preference category. You also must send in your completed contract and $200 deposit by March 1, 2009. 19. I would be interested in living with an international student. ______Yes ______No ______Yes ______No
20. Have you ever been convicted of a felony or any crime against another person(s)? 21. Are you a 21st Century Scholar? ______Yes ______No
I acknowledge receipt of the 20092010 Housing/Food Service Booklet and have read and agree to abide by the same, which are incorporated in this contract by this reference and made a part hereof. I also acknowledge that I have not been convicted of a felony. THIS CONTRACT COVERS THE PERIOD FROM MY CHECK-IN THROUGH THE CLOSING DATE INDICATED IN THE CONTRACT AND IS BINDING FOR THE ENTIRE PERIOD. I agree to abide by the regulations of the University and the terms and conditions of the 20092010 Housing/Food Service Booklet and the 20092010 Student Planner. Failure to abide by this contract or the guidebook is cause for action by the Department of Housing and Residence Life and the University of Southern Indiana. Students signature: ____________________________________________________________________________ Date: __________________________________
Parent/guardians signature: ______________________________________________________________________ Date:___________________________________ (Parent or guardian signature is required when the student is under 18 years of age at the signing of this contract.)
CONTRACT ACCEPTANCE This contract is an academic year contract and is binding from receipt of your contract and deposit of $200 through May 9, 2010. Payment by Check or Money Order Include your name and Student ID number on the check or money order to ensure that your payment is credited properly. Payment by Credit Card The University of Southern Indiana accepts MasterCard, Visa, or Discover payments. To use one of these credit cards to pay your deposit, you must apply online or turn your contract in at the USI Cashiers window. The University will not accept credit card payments over the telephone. The University of Southern Indiana does not waive its governmental immunity by entering into this contract and fully retains all immunities and defenses provided by law with regard to any action based on this contract. This contract does not create a landlord-tenant relationship (see Indianas Security Deposit ActIC 32-7-5-1 et seq.) between the University and the student. CONTRACT ELIGIBLITY Students desiring to live in University housing must maintain nine (9) or more credit hours per semester. Exceptions to this requirement are those students who are enrolled in the University Options program, who are conditionally admitted to the University, or who have written approval from the director of Residence Life. Students who are not making academic progress in their classes (i.e., failing to attend classes, being dropped from class for non-attendance, etc.) are considered in breach of contract and face contract termination (see CONTRACT TERMINATION BY UNIVERSITY). CONTRACT MODIFICATIONS Student-initiated modifications and/or exceptions to the Housing/Food Service Contract are not allowed. Students who believe they have a special circumstance must contact the department of Housing and Residence Life in writing or by e-mail at living@usi. edu. Residence Life reserves the right to modify the provision of services in whatever manner it determines appropriate to better serve student needs. CONTRACT CANCELLATION Full cancellation provisions apply under the following situations (see CONTRACT CANCELLATION FEES). Deposits are forfeited for any cancelled contract after April 1, 2009, for current residents and after June 1, 2009, for new students, even for contracts signed after these deadlines. A forfeited deposit cannot be used toward any Residence Life or University charges, including damage billings. If you cancel your contract prior to the aforementioned deadlines, your deposit will be refunded. This cancellation must be done in writing either by sending a letter to the department of Housing and Residence life, e-mailing living@usi.edu, or filling out the online form at www.usi.edu/res. CONTRACT TERMINATION BY UNIVERSITY The following situations may be cause for contract termination by the University: Delinquent account (non-payment) Disciplinary action Failure to carry nine or more credit hours (three or more hours in summer session) Failure to submit immunization records Failure to make academic progress The University, in the event of any disaster leaving University facilities or any portion thereof uninhabitable or inoperable for more than seven (7) continuous days, may cancel this contract. In addition to all rights contained herein of cancellation, declaration of default, or termination, the University reserves the right to cancel this contract without cause thirty (30) days after mailing written notice of cancellation to the student at the most recent address supplied to the University by the student. Notice will be mailed by certified mail, return receipt request. If the University elects cancellation under this provision, the University will refund any money due to the student according to the refund provisions of this contract. CONTRACT RELEASE PROCESS A student may request to be released from this contract prior to the end of the contract period for any one of the following reasons: arriage as evidenced by a marriage certificate (marriage must have M occurred during the contract period) Graduation from the institution ithdrawal from the institution after September 1, 2009, for Academic Year W contract, and after January 14, 2010, for spring-only contract ssignment to a University-sponsored internship program, research projA ect, co-op program, student teaching, military service, or other program that requires living away from Evansville or the Vanderburgh County area significant, unavoidable, and unanticipated change in circumstances A beyond the residents control, which occurs after the contract begins Finding less expensive housing off-campus, failing to get desired room assignment or roomates, being judicially removed from housing, or failing to receive financial aid because of ineligibility will not be considered a valid reason for contract release without the application of contract cancellation fees or refund of deposit. All cancellation penalties will be applied. In order to provide information to state and University auditors offices, students are required to provide documentation that verifies their request. Verification must be in the form of financial records, medical releases, unemployment notifications, etc. Personal letters from parents or students with no additional forms of documentation do not provide sufficient verification. Review is based on the students initial claims of hardship. Additional claims after review will not be considered. Withdrawal from the University If you withdraw from the University of Southern Indiana during the contract period, you must: ontact the Registrars Office and withdraw from classes C C omplete a Contract Cancellation/Deposit Request form ontact the Food Service office if you have a meal plan C C ontact the Financial Assistance Office if you have any form of financial assistance
P08-5137
Move out of Housing and Residence Life facilities within 24 hours of your withdrawal date. A Contract Cancellation/Deposit Request form must be on file in the Residence Life Center. Any unused portion of room and board will be credited to your account and will be based on the date you officially checked out of Residence Life. Students who withdraw prior to, or as a result of, pending judicial action will be assessed full cancellation fees as outlined in this contract. This contract continues until such time as Residence Life approves an official contract release and the student vacates the facilities. Any property left in unit after vacating will be considered abandoned and disposed of. No-Shows An applicant who does not officially check into an assigned room by 4 p.m. on the first day of classes will be considered a no-show and the contract will be terminated. A cancellation fee of $200 will be assessed and the deposit will be forfeited. If you will be arriving past the 4 p.m. deadline on the first day of class, see Late Check In information in the contract booklet. CONTRACT RELEASE PROCEDURE Contract Cancellation/Deposit Request forms are available in the Residence Life Center or online at www.usi.edu/res. You must write a summary explaining the grounds for your request and must attach any supporting documentation regarding this summary. The director of Residence Life, or his/her designee, will review your request. You will then receive a formal response (within 10 business days) from the reviewer indicating the decision rendered. Failure to provide supporting documentation may result in denial of any refund. HOUSING CONTRACT CANCELLATION FEES A student who voluntarily, or for any of the reasons listed under Contract Cancellation, Contract Termination by University, or Contract Release Process, officially cancels their housing after checking in will forfeit the deposit and be assessed cancellation fees based on the following schedule. Cancellation fees are assessed to recoup part of the spring semester cost for housing: Cancellation Fee Schedule for 20092010 Academic Year Contract Week 1: 10% of the fall semester fee, plus 40% of the spring semester fee Week 2: 20% of the fall semester fee, plus 40% of the spring semester fee Week 3: 30% of the fall semester fee, plus 40% of the spring semester fee Week 4: 40% of the fall semester fee, plus 40% of the spring semester fee A billing week for Housing starts on Sunday and ends on Saturday Cancellation Fee Schedule for Spring 2010 only Contract: Before the 4th week: 40% of the spring semester fee After the 4th week: No housing refund
NOTE: Cancelled private rooms will result in the same penalties, even if the student remains in housing.
MEAL PLAN CANCELLATION FEES (through Food Service) Red Eagle, White Eagle, and Blue Eagle Meal Plan Cancellation* Week 1: 10% of the Meal Plan Fee Week 2: 20% of the meal plan fee Week 3: 30% of the meal plan fee Week 4: 40% of the meal plan fee After the 4th week: No meal plan refund billing week for the meal plan begins on Friday and ends on Thursday. A Cancelled meal plans begin on the Friday following review and approval by the Food Service Appeal Committee. ancellation of meal plans must be handled in person at the Food Service C office, 812/464-1859, located on the lower level of the University Center. With approval of your meal plan cancellation, dining dollars are refundable for the full unused amount. itanium, Platinum, and Gold Meal Plan Cancellation: These plan T options are non-refundable unless requested within four weeks from the date of purchase. Proof of withdrawal from the University and housing will be necessary for the refund process. BREACH OF CONTRACT The University reserves the right to terminate the contract if a resident fails to comply with any of the rules and regulations contained herein. The following process will be followed in cases of contract termination: otice of alleged violation N eeting with a Residence Life administrator M otice of contract termination N viction may take place immediately upon notice E Decisions of the director of Residence Life or his/her designee are final. No additional appeals are afforded under this contract. Students may be required to follow the USI Student Rights and Responsibilities disciplinary process at the discretion of the director of Residence life or his/her designee. In these cases, charges will be filed through the assistant director for Student Conduct. CONTRACT TRANSFER The Housing/Food Service Contract may not be transferred or reassigned. Meal access and facilities may be used only by the assigned individual(s). Deposits may not be transferred from person to person. BILLING INFORMATION Students who register early will receive a University bill approximately six weeks before classes begin. Students attending open registration are expected to pay their balance in full at that time. Students will not be permitted to re-enroll or receive transcripts if any University charge is unpaid. Any financial assistance received will be applied to the balance owed, regardless of payment arrangements. Any funds that remain after all charges are paid will be refunded by the Bursars office. Breach of Payment Upon breach of any of these terms, the University may declare you in default. All default decisions made by the University are final. Acceptance by the University of student payments after default does not rectify your default unless full payment of total assessment is received. Upon declaration of default, the University may: eclare the entire amount due and payable D estrict room access by re-coring the apartment door lock ($60 charge) R or re-coding a residence hall lock ($60 charge) ake any other appropriate action as authorized by University regulations T All costs incurred by the University when attempting to collect a debt are charged to the student.
INTERNATIONAL STUDENT TRANSFER FORM The INTERNATIONAL STUDENT TRANSFER FORM must be completed by international applicants who are applying to the University of Southern Indiana and ATTENDING ANOTHER SCHOOL IN THE U.S. This form is a necessary part of the application process for those attending another U.S. school (high school or university). Please give this form to the foreign student advisor at the school where you are currently enrolled. If you are not attending an institution at this time and are in the United States, this form should be completed by the foreign student advisor at the school you most recently attended. TO BE COMPLETED BY APPLICANT: Name Address City/State/Zip Code Telephone Signature You should attach to this form photocopies of: a. Your most recent I-20 (front and back). b. Your I-94 (front & back). This is a small white card stapled in your passport. c. The U.S. Visa page from your passport. d. The identification page from your passport. (The page with your photograph.) After you have completed the above spaces and attached items a-d, give the form and photocopies to your international advisor. TO BE COMPLETED BY INTERNATIONAL STUDENT ADVISOR: 1. Is this student currently enrolled at your institution? ______yes ______no 2. Is this student in F-1 status? ______yes ______no (If no, list status ___________) 3. Date student first began F-1 status: ______________to_____________ At what institution______________________________________ 4. Dates of full time enrollment at your institution (if different from above) ___________________________to____________________________ 5. Is this student in status with the Immigration and Naturalization Service? 6. Would this student be permitted to continue or return to your institution? ______yes ______no (If no, please explain)
Additional comments:
Name Title Institution Signature____________________________________________Date_____________________________ Office of Admission University of Southern Indiana 8600 University Boulevard Evansville, IN 47712 USA
Please return to:
USA
CANADA
TEL: 360-724-0547 FAX: 360-724-0548

NAME OF STUDENT: __________________________________________________
West Texas A&M University

A Member of Texas A&M University System
STUDENT NAME:______________________________

UNDERGRADUATE & ENGLISH______ GRADUATE & ENGLISH______ START DATE FOR ENGLISH____________ MAJOR AREA OF STUDY______________ This application package must include the following items: 1. 2 Page International Student Application for Admission Form 2. US$140 application & Courier fees payable to ESLI 3. Official Original Certified original school transcripts 4. Official Original Certified School graduation diploma 5. Sponsors Financial Guarantee form, signed by sponsor 6. Original Sponsors Bank statement 7. 2 letters of recommendation (optional) 8. Study plan 9. Copy of students passport 10 Application for Housing
ENGLISH ONLY
WTAMU/ESLI ONLY______ START DATE____________ ENDING DATE___________ This application package must include the following items: 1. 2. 3. 4. 5 2 Page International Student Application for Admission Form US$140 application & Courier fees payable to ESLI Sponsors Financial Guarantee form, signed by sponsor Original Sponsors Bank statement Copy of students passport
Mailing Address:
ESLI 4528 Humphrey Hill Road Sedro Woolley, WA 98284 USA Tel: 360-724-0547 Fax: 360-724-0548 Email: esli@esli-intl.com Website: www.esli-intl.com
May 2004
WEST TEXAS A&M UNIVERSITY INTERNATIONAL STUDENT APPLICATION FOR ADMISSION
Return all admission material to: International Student Office WTAMU Box 60745 Canyon, Texas 79016-0001 U.S.A.
For more information concerning the admission process, telephone (806)651-2073 or fax (806)651-2071. NOTE: A non-refundable evaluation/application fee of $75 is required with each application. Semester and year admission is desired: Semester ______________________________ Year ______________
U.S. Social Security number ___________________________________________________ Name __________________________________________________________________________________________________________________

last (family) first middle maiden
Other name(s) which might appear on previous academic records _______________________________________________________________ Permanent address in home country _________________________________________________________________________________________________________
Telephone number (with country code)___________________________________
E-mail address_____________________________
Current mailing address _________________________________________________________________________________________________________

Telephone number (with country code)___________________________________ Birth date ______________________________

month/day/year
E-mail address_____________________________ Gender: male_____ female_____
Marital status:
single_____ married_____
Country of birth __________________________________________
Country of citizenship ___________________________________________ yes_____ no_____ I-20 Admission number _____________
If you come to the United States, will your spouse and/or children come with you?
Students Currently in U.S.A.: Date of entry ____________ Type of visa at entry ____________
Passport number ______________ Passport issued by ________________________________ Passport valid until ______________ What institution issued the I-20 for your current visa? ____________________________________________________________________ Are you currently enrolled in the institution? yes_____ no_____ Date I-20 expires ______________________________________
EDUCATIONAL DATA Intended major at West Texas A&M University ________________________________________________________________________________ Type of degree you are seeking: bachelors degree_____ masters degreethesis (research)_____ masters degreenon-thesis_____ Have you taken the ACT/SAT? yes_____ SAT scores: no_____ Were your scores sent to WTAMU? yes_____ Total____________ no_____
Verbal ____________
Math____________
Test date __________________________
ACT score: ____________
Test date ___________________________ Were your scores sent to WTAMU? yes_____ no_____ Analytical____________ Test date ______________________
Have you taken the GRE/GMAT? yes_____ no_____ GRE scores: Verbal____________ GMAT total score: ____________
Quantitative____________
Test date ______________________ (WTAMU requires a TOEFL score of 525 for
Have you taken the Test of English as a Foreign Language (TOEFL)? yes_____ no_____ undergraduate students, 550 for graduate students.) Has your official TOEFL score been sent to WTAMU? yes_____ no_____
Score __________ Test date___________________
What is your native language? _______________________________ Other languages _____________________________________________ Intensive English Students: Intensive English program only_____ ESLI start date___________________ Intensive English and degree program_____
Are you currently enrolled in an intensive English language program? yes_____ no_____
If yes, where?______________________________________________________________________________________________________ EDUCATIONAL BACKGROUND List in chronological order each school or institution you have attended; begin with secondary school and end with the present. Include each school or institution attended, the dates attended and the degrees received. If you need additional space, use a separate sheet of paper.
Type of School: Secondary, College, University, Etc. Attended From To Month/Yr Month/Yr / / / / / / / / / / / / / / / / / / / / Actual Name of Diploma, Degree or Certificate Your Date Age in Received School
Name of School or Institution and Location
How did you learn about West Texas A&M University?_________________________________________________________________________ Were you referred to West Texas A&M University by an agency? yes_____ no_____ Name of agency ___________________________________________________________________________________________________ Address ___________________________________________________________ Telephone ___________________________________
Provide the following information on a person (parent, guardian, relative) who could be notified in case an of emergency: Name _______________________________________________________ Relationship ________________________________________ Telephone ___________________________________
Address ___________________________________________________________ RESIDENCY INFORMATION
Texas Higher Education Coordinating Board rule 21.38 requires each student to provide substantiating documentation to affirm residence for tuition purposes. It also requires an Oath of Residency required by state law to be signed by each applicant. If you have attended school or resided out of state, additional proof of residency may be required.
OATH OF RESIDENCY
I understand that information submitted here will be relied on by University officials to determine my status for residency. I authorize the University to verify the information I have provided. I agree to notify proper institution officials of any changes. I certify that the information is complete and correct, and I understand that submission of false information is grounds for rejection of my application, withdrawal of any offer of acceptance, cancellation of enrollment or appropriate disciplinary action.
Date _________________________________
West Texas A&M University serves people of all ages regardless of socioeconomic level, race, color, gender, religion, disability or national origin. WTAMU is an affirmative action/equal employment opportunity institution. I CERTIFY THAT ALL INFORMATION CONTAINED IN THIS APPLICATION IS COMPLETE AND ACCURATE, AND I UNDERSTAND THAT SUBMISSION OF INACCURATE OR INCOMPLETE INFORMATION MAY RESULT IN TERMINATION OF MY APPLICATION, ENROLLMENT AT WEST TEXAS A&M UNIVERSITY OR DISMISSAL FROM THE UNIVERSITY. I understand that as a student of West Texas A&M University, an account will be established in my name. I am aware that financial transactions will be posted to this account, and the University will extend credit to me in anticipation of payment on a prescribed due date. I understand that if I fail to repay any debt when due, I will be assessed late charges. I further agree to pay all attorneys fees and other reasonable collection costs necessary to collect amount not paid when due.
Date _________________________________
West Texas A&M

U N I V E R S I T Y
International Student Office
SPONSORS FINANCIAL STATEMENT

Name of Applicant (Family name) (First name) 1
I certify that I am financially able and willing to support the above named student while he/she is pursuing a course of study at West Texas A&M University. I hereby guarantee to provide sufficient funds to pay for the tuition, fees, medical insurance, and living and personal expenses of the student while studying at West Texas A&M University. Signature of sponsor Sponsors name (Print) Relationship to Student Sponsors Address Date _______________ __________________________________________________ __________________________________________________ __________________________________________________
Sponsors e- mail address __________________________________________________ _____ family members will accompany student.
Name Relationship Date of Birth Country of Birth
An additional US $3,000 for spouse and $1,500 for each dependant will be required in financial support. Note: A bank letter must be attached to this form providing evidence of the funds available to meet the expenses of the student. I, ____________________________ (Applicants name) certify that the information provided above is correct and complete and that I am responsible for all expenses incurred during my study at West Texas A&M University not covered by the sponsor. Applicants Signature ___________________________ Date ___________________
A Member of The Texas A&M University System WTAMU Box 60745 Canyon, Texas 79016-0001 806-651-2073 Fax 806-651-2071
Date of WTAMU Enrollment____ ____ ____

mo day yr
West Texas A&M University Student Immunization Form

West Texas A&M University ESLI policy requires students to document immunizations in English for the following diseases. If you intend to enroll at the University, please complete and return this form to WTAMU ESLI prior to the start of your first semester. Call 360-724-0547 if you have questions. Name _________________________________________________University ID No. ________________________
Last First Middle
Permanent Address _____________________________________ Phone __________________________________ City__________________________________ State ______ Zip __________ Date of Birth______________________
Month Day Year
Note: MMR vaccine is recommended to provide protection against measles, mumps and rubella Rubeola: (ten day measles): Must have the following: Two immunizations required at least thirty days apart (after 1967 & not before first birthday) 1st immunization .........................................................month/day/year received _____/_____/_____ 2nd immunization.........................................................month/day/year received _____/_____/_____ Or measles titer............................................................month/day/year tested _____/_____/_____ Results_________ Or physician-diagnosed measles disease............................month/day/year diagnosed _____/_____/_____ Vaccine not required if born before January 1, 1957_____ (Please check only if applicable)
Mumps: Must have one of the following:

Rubella: (German/three day measles): Must have one of the following:

Tetanus/Diptheria: TD booster within last 10 years required (Tetanus alone not acceptable)
Tuberculin Skin Test (TB)(Mantoux only):

Date given_____/_____/_____ Date Read_____/_____/_____ Results_______ mm duration Signature of physician or registered nurse reading test _______________________________________________ Chest x-ray required if reading 10mm or greater: Date of chest x-ray__________ Results_______
Meningococcal Conjugate (MCV4) (Meningitis) REQUIRED at least 10 days prior to moving on campus
One immunization.................month/day/year received _____/_____/_____
Physicians Signature: Note: If not signed by a physician/registered nurse, you must provide proof of documentation
Name (print): ____________________________________________ Signature: ______________________________ Address: ______________________________________________________________________________________________ Phone: ______________________________________________FAX: _____________________________________

1. Anaphylactic reaction to a vaccine contraindicates future doses of the vaccine 2. Anaphylactic reaction to a vaccine substance contraindicates the use of vaccines containing that substance
1. Anaphylactic reaction to eggs or neomycin* 2. Pregnancy 3. Known altered immunodeficiency (hematologic and solid tumors, congenital immunodeficiency, or long term immunosuppressive therapy) 4. Measles vaccine should not be given for at least six weeks (preferably three months) after a person has received IG, whole blood, or other antibody containing products

1. Students having recent viral infections or live virus vaccines (i.e. MMR). To obtain an accurate result when infection is strongly suspected, it is best to repeat testing several weeks after the illness, and 4-6 weeks after administration of the vaccine. 2. Past documented history of positive Mantoux. Chest x-ray required. * Vaccinate only with extreme caution. Consult protocols for vaccinating such persons (J Pediatrics l983; 102:196-9 and JPediatrics STL96K0083 1988; 113:504-6)
USA
CANADA
TEL: 360-724-0547 FAX: 360-724-0548

NAME OF STUDENT: __________________________________________________
Western Kentucky University

STUDENT NAME:______________________________

UNDERGRADUATE & ENGLISH______ GRADUATE & ENGLISH____________ START DATE FOR ENGLISH____________ MAJOR AREA OF STUDY______________ This application package must include the following items: 1. A completed, signed Application for Admission (2 page WKU Undergraduate application OR 2 page WKU Graduate application) 2. US$140 Application & courier fees payable to ESLI 3. Official certified original school transcripts 4. Original certified school graduation diploma 5. Sponsors Financial Guarantee Form (signed by sponsor) 6. Original Bank statement of sponsor 7. 2 letters of recommendation (required for Graduate applicants) 8. Study Plan (required) 9. Resume (Required for all Graduate Applicants) 10 Copy of students Passport 11 Residence Hall Application
ENGLISH ONLY
ESLI ONLY______ START DATE__________ ENDING DATE___________ This application package must include the following items: 1. A completed, signed Application for Admission (2 pages) 2. US$140 application & courier fees payable to ESLI 3. Sponsors Financial Guarantee Form (signed by sponsor) 4. Original bank statement of sponsor 5. Copy of students Passport AGENCY: ______________________________ COUNSELOR:___________________________ ADDRESS:______________________________ ________________________________________ CITY:______________COUNTRY:___________ TEL:_______________ FAX:________________ EMAIL:_________________________________
Mailing Address:
ESLI 4528 Humphrey Hill Road Sedro Woolley, Washington 98284 USA Tel: 360-724-0547 / Fax: 360-724-0548 Email: esli@esli-intl.com Website: www.esli-intl.com
International Undergraduate Application For Admission

Please PRINT Clearly Enrollment Level Beginning Freshman
Family/Last
Transfer
Given/First
Readmission
Foreign Exchange
Middle/Maiden
Name (as listed on passport)________________________________________________________________________________ Indicate name on transcripts, if different from name above ____________________________________________________ U.S. Social Security Number ___ ___ ___-___ ___-___ ___ ___ ___
(if applicable)
Gender
Female
Male
Email ___________________________________________________ Birth Date ___ ___/___ ___/___ ___ (MM/DD/YY) Mailing Address ______________________________________________
No. & Street
Permanent Address (if different from mailing) ___________________________________________________

No. & Street
City
______________________________________________
State/Province
___________________________________________________
City State/Province
Country
________________________________________________________
Postal Code
______________________________________________________________
Country Postal Code
Telephone
______________________________________________
___________________________________________________
Telephone
Emergency Notification __________________________________________________________________________________

Name Relationship Street City/State/Country/Postal Code Phone
U.S. Citizen
Yes
No
If No, permanent resident?
Yes
No
If Yes, Alien Registration No. _______________________
Country of Citizenship _________________________ City & Country of Birth ____________________________________ Are you Currently in the U.S.
(If currently in the U.S., please send copies of your visa, I-94 card, and I-20 or DS-2019 (formerly IAP-66))
Yes
No
If Yes, what is your current visa status?________________________________

Other
Ethnic Origin American Indian or Alaska/Native
Asian/Pacific Islander Black/African American Hispanic/Latino White (This information will NOT be used in making admission decisions; however, it is necessary for record keeping purposes.)
Semester of Enrollment (check one) Year _________
Fall-Aug
Spring-Jan
Summer-May/June/July
English as Second Language Institute Applicants: (check one) Which degree are you seeking Code of Major ________ Associate Degree
Intensive English Program Only Intensive English Program and Degree Program Bachelor Degree Non-Degree Seeking
(List your desired program of study from the list of majors included)
Name of Major ______________________________ Concentration ____________________ (month/year) Took or will take ACT ___ ___/___ ___ Took or will take SAT ___ ___/___ ___ Took or will take TOEFL ___ ___/___ ___
State/Province Country
Have you taken the American College Test (ACT) Yes No Scholastic Aptitude Test (SAT) Yes No English as Foreign Language (TOEFL) Yes No
Name City
High School name and location ____________________________________________________________________________ High School Graduation Date ___ ___/___ ___ (month/year)
Chg name/SS ___________ App # _________________ TOEFL ________________ FINCER _______________ FEE ___________________ _______________________ IQ ______PIP___________ ACT/SAT ______________ HST/FHST _____________ Rank/Class _____________ PCC ___AP___ T___ E___ _______________________
or
Passed GED on ___ ___/___ ___ (month/year)
R___________________ W 407 409 411 M R S N ___________________ AG _________________ I____________________
Decision Comp Ltr MR Ltr ________________________________________________________ ________________________________________________________ ________________________________________________________ ________________________________________________________ ________________________________________________________
How did you hear about Western Kentucky University ? _______________________________________________________ If you are currently in high school, please list below the classes you are currently taking or will take prior to entering WKU. High School students in last year should list their entire schedule for the year. If you are not currently enrolled in any school, please write NONE. Course ________________ ________________ ________________ Credits _________ _________ _________ Term/Year Taken ______________ ______________ ______________ Course _________________ _________________ _________________ Credits _________ _________ _________ Term/Year Taken ______________ ______________ ______________
List in chronological order each school or institution you have attended, begin with secondary school and end with the present. Include each school or institution attended, the dates attended and the degree received. If you need additional space, use a separate sheet of paper. Name of School or Institution and Location Type of School: Secondary, College, University, Etc. Attended From To (MM/Year MM/Year) Actual Name of Diploma, Degree or Certificate Date Received Your Age In School
Currently enrolled in last school attended ? Eligible to return to the last school attended? On academic probation at the last school attended ?
Yes Yes Yes
No No No
Do you have a parent, stepparent or grandparent who graduated from WKU? Yes No If yes, please list the following: _______________________________________________________________________
Name Relationship Birth Date Year of Graduation
Have you ever been convicted of a crime other than a minor traffic violation or is a criminal charge o ther than a minor traffic violation pending against you? Yes No
(If yes, enclose an explanation with your application. The application cannot be processed without an explanation.)
Have you ever been suspended or dismissed from any school, colle ge or university?
(If yes, enclose an explanation with your application. The application cannot be processed without an explanation.)
Yes
No
I hereby affirm that all information supplied in this application is complete and accurate. I understand that withholding or giving false information will make me ineligible for admission to WKU or ineligible to continue in school if admission has been granted, in whole or in part, on the basis of such information. ____________________________________________________________________________________________________ Signature of Applicant Date (MM/DD/YY)
*Mail with check or money order for $30 to the address below, or supply credit card information
MasterCard Visa Discover Return to: Credit Card Number ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ Expiration Date ___ ___/___ ___ Card Holder Name _______________________________Signature ______________________ Office of Admissions Western Kentucky University 1 Big Red Way Bowling Green, KY 42101-3576 U.S.A.
A $35 non-refundable application fee must accompany this form. This excludes former WKU masters students and/or former masters applicants. FOR OFFICE USE ONLY
PLEASE PRINT CLEARLY INTERNATIONAL GRADUATE STUDIES APPLICATION FOR ADMISSION Are you transferring from another US school? Yes No
_______________ Date
________________ Receipt #
_____________ Initials
FORM I
Visa status/type ________________________ Yes

Given/First
Have you previously applied for admission to Western Kentucky University?

As written in passport Family/Last
No
If yes, when? __________________________

Middle/Maiden
1. Full Legal Name ____________________________________________________________________________________________________ 2. Social Security/Identification No. _____________________ (If none, leave blank) 3. Address: _______________________________________________________________________________________________________________
No. & Street City
_______________________________________________________________________________________________________________
State/Province Country Zip Code
4. Email _____________________________________________________________________ 5. Telephone Nos. Current/Local ________________________________________ Work ____________________________________________ 6. Emergency Notification ______________________________________________________________________________________________
Name Relationship Telephone Number
_____________________________________________________________________________________________
No. & Street State/Province Country Zip Code
7. Gender
Female
Male
8. Birthdate ___________________________
Month/Day/Year
9. Country of Citizenship ____________________________ 10. U.S. Citizen 11. Ethnic Origin: Yes No
If no, permanent resident? Yes No Alien Registration No. ______________________________________
Black/African American (2)
American Indian or Alaskan Native (3)
Asian/Pacific Islander (4)
Hispanic/Latino (5)
White (6)
(This information will NOT be used in making admission decisions; however, it is necessary for record keeping purposes.)
12. Undergraduate Degree __________________________________________________________

Institution
______________
Degree
_______________
Graduation Month/Year
13. Previous Graduate Study _______________________________________________________

Institution
______________
Degree/Hours
_______________
Graduation Month/Year
14. Have you taken the
**G.R.E. **GMAT TOEFL
Yes Yes Yes
No Date(MM/YY)______________ No No Date(MM/YY)______________ Date(MM/YY)______________ Fall Spring
If yes, scores reported to Western? If yes, scores reported to Western? If yes, scores reported to Western?
Yes Yes Yes
No No No
15. Semester of Enrollment: (Choose only ONE) Year _________
16. For which ONE of the following admission categories are you applying? Degree Seeking Second Masters degree Certificate Program
ESLI START DATE:________________________
List below your desired program of study.

Program Code
(MAE, MPH, )
Code of major
(165, 109, 151)
Name of major_________________________________ Concentration(if applicable)_______________________ (You must choose a Concentration in MPH)
Concentration Code
(PHED, PEXS)
Master of Arts in Education (MAE) 043 042 145 047 Counseling MNHC Mental Health Counseling MHMF Marriage/Family Therapy Educational and Behavioral Science Studies Student Affairs in Higher Education Adult Education Master of Science (MS) Agriculture Biology Chemistry Communication Disorders Web-based CD program Computer Science Geoscience Library Media Education Mathematics Physical Education PEXS Exercise Science PPED Pedagogy - Traditional PPED Z6 Online PE Recreation and Sports Administration Technology Management
149
Master of Science Nursing (MSN) MSNA Nurse Administrator MSNE Nurse Educator MSNP Nurse Practitioner Certificate Programs (CER) Community College Faculty Prep Womens Studies Leadership Studies History Organizational Communication Geographic Information Systems Complementary Health Care Addictions Counseling and Health Education Autism Spectrum Disorders Nursing Education (Post MSN) Nursing, Primary Care (Post MSN)
052 056 059 114 117 072 083 085 090
162 161 163 165 175 203 206 218 441 172 176
410 109 067 069 049 078 041 092
105
Master of Arts (MA) Applied Economics Communication English Folk Studies Mathematics History Administrative Dynamics Psychology MACL Clinical MAAE Experimental MAGE General MAIN Industrial Organizational I/O Sociology
051 157
Master of Public Administration (MPA) Master of Social Work (MSW) Master of Public Health (MPH) PHED Public Health Education PHEH Environmental Health Master of Health Administration (MHA)
112 147 057
Specialist in Education Degree (EdS) Counselor Education School Psychology Master of Business Administration (MBA)
152
095 045
153
DEADLINES: Admission files must be complete by April 1 for fall semester or September 1 for spring semester. For transfer students only deadlines are May 1 for fall semester and October 1 for spring semester. These deadlines will be enforced.
APPLICATION INSTRUCTIONS
APPLICATION MUST BE ACCOMPANIED BY A NON-REFUNDABLE $35 APPLICATION FEE WHICH IS SUBJECT TO CHANGE AT ANY TIME. This excludes WKU former masters students and/or former masters applicants. DEGREE-SEEKING STUDENTS must have forwarded to the Graduate Studies Office one Official transcript from each undergraduate degree-attaining institution (unless WKU) and from any institution (except WKU) where course work has been pursued. The applicant who has not yet completed the undergraduate degree should forward one official transcript now and one after the degree is completed **All degree-seeking students must submit appropriate standardized test scores regardless of their undergraduate grade point average. With two exceptions, all degree programs require the Graduate Record Examination (GRE) General Test. The exceptions are the Master of Business Administration, which requires the Graduate Management Admission Test (GMAT) and the Master of Arts in Administrative Dynamics, which accepts either the GRE or GMAT. Standardized test scores must be received by the Office of Graduate Studies prior to admission. The admission decision will be based upon both the transcript grade point average and the test score.
STATEMENT OF COMPLIANCE Western Kentucky University is committed to equal opportunity in its educational programs and employment. It is an equal opportunity-affirmative action employer and does not discriminate on the basis of age, race, color, religion, sex, sexual orientation, national origin, or disability. On request, the University will provide reasonable accommodations, including auxiliary aids and services, necessary to afford an individual with a disability an equal opportunity to participate in all services, programs, activities, and employment. The University has published policies and procedures for investigating and/or addressing discrimination or harassment in its educational programs and/or employment. If you believe you have experienced discrimination or harassment in such programs, activities, or employment, the Universitys policies and procedures are published in the Hilltopics: A Handbook for University Life; the Western Kentucky University Personnel Policies and Procedures Manual; and the Catalog. These publications, including information about University procedures, are available in the following locations: Equal Opportunity/ADA Compliance Office Room 445 Potter Hall Western Kentucky University 270-745-5121 Office of Human Resources Room 42 Wetherby Administration Bldg. Western Kentucky University 270-745-5360 Office of the President 1906 College Heights Blvd Western Kentucky University 270-745-4346
Inquiries about alleged discrimination may also be made to the Office for Civil Rights, The Wanamaker Bldg., Suite 515, 100 Penn Square East, Philadelphia, PA 19107, (215) 656-8541; the Kentucky Commission on Human Rights, 832 Capital Plaza, 500 Metro Street, Frankfort, KY 60601, (502) 564-5530; or the Equal Employment Opportunity Commission, 600 Martin Luther King, Jr. Place, Suite 268, Louisville, KY 40402, (502) 582-5851.
I hereby affirm that all information supplied in this application is complete and accurate. I understand that withholding or giving false information will make me ineligible for graduate admission to WKU or ineligible to continue in school if admission has been granted, in whole or in part, on the basis of such information. Signature of applicant Date (mm/dd/yyyy)
Mail with check or money order for $35 to: Graduate Studies and Research, 1906 College Heights Blvd. #11010, Bowling Green, KY 42101-1010 or supply credit card information below.
Master Card
Visa Discover
Card Number_________________________________________Expiration Date___________ V-Code_______________(3 digit number on the back of the card) Card Holder Name____________________________________________________________ Card Holder Signature__________________________________________________________
Revised 05/10/2007
Western Kentucky University

Sponsors Financial Guarantee
Name of Student: _________________________ ___________________________ (Family Name) (Given Name) I certify that I am financially able and willing to support the above mentioned student while he/she is pursuing a course of study at Western Kentucky University. I hereby guarantee to provide sufficient funds to pay for the tuition, fees, medical insurance, living and personal expenses of the student while studying at Western Kentucky University.
Signature of Sponsor: __________________________________________________ Relationship to Student:_________________________________________________ Date: __________________________________________________
_________family members will accompany student
Name
Relationship
Date of Birth
Country of Birth
An additional US$5,000 for Spouse and US$3,000 per child per month will be required in financial support documents. An original bank letter or statement of account must be attached to this form providing evidence of funds available to meet the expenses of the student.
OFFICE
USE
ONLY RRS RRD AD
WESTERN KENTUCKY UNIVERSITY RESIDENCE HALL HOUSING AGREEMENT

PLEASE PRINT LAST NAME FIRST NAME (FULL LEGAL) ( ) HOME PHONE NUMBER MIDDLE NAME NAME YOU GO BY
ASSIGNMENT:
SOCIAL SECURITY NUMBER OR WKU ID
DATE OF BIRTH
E-MAIL ADDRESS
DATE RECEIVED: __________________________ TIME: __________________________
PERMANENT ADDRESS _______________________________________________________________________________________________________________________________________ STREET CITY STATE ZIP CODE AGREEMENT BEGINNING (check one) ____ Fall Semester Year ____ ____ Spring Semester Year ____ GENDER ____ Male ____ Female CLASSIFICATION ____ Freshman ____ Sophomore ____ Junior ____ Senior ____ Graduate RESIDENT STATUS ____ New ____ Returning ____ Transfer CURRENT ASSIGNMENT ____________________ Hall HOBBIES/INTERESTS (Select all that apply.) / Room _____Early (before 11pm) _____Late (after 11pm) MOST IMPORTANT PREFERENCE (Check Only One) ____ Single Gender ____ Residence Hall ____________________________ ____ Specific Room ____________________________ ____ Roommate ____ Private (space permitting) ____ Themed Living Option _________________________ ____ Living/Learning Community ___________________ I prefer to go to bed: ACADEMIC COLLEGE OR MAJOR ____ Arts & Humanities ____ Education ____Business ____Health & Human Services
RECEIPT NO: __________________________ CLERK: __________________________ ____ MAIL ____ WINDOW ____ RENEWAL ____ NEW AP
____ Science & Engineering ____Undecided
HMF CREATED/UPDATED: __________________
SPECIAL NOTES: ____ Anime/Animation ____ Bible Study ____ Computers ____ Cooking ____ Outdoor Activities ____ Shopping ____ Performing Arts ____ Physical Fitness ____ Reading ____ Sports ____ The Environment ____ Travel ____ Video Games ____ Volunteerism
HOURS: _____________ GPA: ____________
____ Cultural Exploration ____ Role Playing ____ Musical Instruments ____ Science Fiction
__________________________________________ __________________________________________ __________________________________________ __________________________________________
MUSIC PREFERENCES (Check all that apply) SMOKING PREFERENCE SPECIAL NEEDS ____ Physical ____ Medical *For special accommodations, contact Student Disability Services @ (270) 745-5004 Roommate PREFERENCE: LAST NAME FIRST MIDDLE Are you a smoker? _____Yes _____No Would you object to a roommate who smokes? _____Yes _____No Have you received a Meningitis vaccination? _____Yes _____No _____Do Not Know ____ Pop Rock ____Hard Rock ____ Alternative ____Other: ____ Rap _________________ ____ Country ____ Contemporary Christian
__________________________________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________
SOCIAL SECURITY NUMBER
This document, when submitted with appropriate signature(s) and a $150.00 deposit, is a request to rent Western Kentucky University residence hall space. I have read and accept the Terms and Conditions outlined in this agreement. I understand that these preferences will be honored if possible, but cannot be guaranteed. I verify that the information is true and accurate.
Signature (Residents ) ___________________________________________________________________________ Date __________________ Age _____________
Signature _____________________________________________________________________________________ Date __________________ Parent or Guardian if resident is under 18 years of age
SEND THIS AGREEMENT ALONG WITH YOUR DEPOSIT TO: OFFICE OF HOUSING, WESTERN KENTUCKY UNIVERSITY, 1906 College Heights Blvd. #11093, BOWLING GREEN, KY 42101-1093
RESIDENCE HALL HOUSING AGREEMENT Terms & Conditions I. REQUIRED HOUSING POLICY 1. Freshmen and sophomores (less than 60 hours) are required to live on campus, space permitting. Exemptions include students who are: veterans of military service (181 days or more), married, have dependent children, 21 years of age or older, members of fraternities or sororities living in chapter houses (sophomores only), or commuting from their parents permanent address and primary residence. Requests for exemption based upon special circumstances (defined as unique and unusual) will also be considered. Students who live on campus will not be granted an exemption to commute once the contract period begins. A fee of $1000 is assessed to students who are in non-compliance with this policy. II. ELIGIBILITY 1. All full-time WKU, Bowling Green Community College and exempted part-time students may live on campus. 2. If a resident fails to enroll or pay fees and is therefore not an enrolled student, the resident agrees to vacate the premises within 48 hours. III. PERIOD OF AGREEMENT 1. Upon execution of this Agreement by both parties and payment of the deposit, this contract becomes effective and constitutes a binding Agreement for the full academic year (Fall and Spring Semesters) or the remaining portion thereof. 2. Any student who remains enrolled full-time, but withdraws from University Housing during the contract period without being released from the Agreement, will: forfeit the deposit, be assessed a room charge through the official date of withdrawal, and be assessed a $750 contract termination fee. IV. SERVICES PERIOD 1. Provided residence hall space is available, the University agrees to furnish a space and use of public areas in the residence halls. 2. The University provides housing for the recess periods of Thanksgiving, semester break & Spring Break in Pearce Ford Tower. Residents interested in staying on campus during these periods should apply to Pearce Ford Tower. All other halls will close for these periods, but residents may leave personal belongings in their room. V. HOUSING DEPOSIT 1. A $150 housing deposit is required to file this Agreement, and serves as a combination room reservation, damage, cancellation and room checkout deposit. 2. This deposit may be carried over to the following academic year upon fully meeting the terms of the Agreement for the current academic year. 3. This deposit does not apply toward the semester housing fee or other University obligations unless the resident fails to meet the payment schedule and therefore accumulates a past due obligation with the University. 4. Forfeiture of all or part of this deposit may result from cancellation of this Agreement, failure to check-in by the first day of classes, failure to check out properly, or having room damages and/or missing equipment. VI. ROOM ASSIGNMENTS 1. The University agrees to determine room assignments based upon date of receipt,
indicated preferences, and priority status. Returning Residents who renew their Agreement prior to the established deadline are given "priority status" and reassigned first. Incoming freshmen and transfer students are assigned next. Returning students who apply after the deadline are not guaranteed a hall/room assignment for the upcoming academic year. 2. Roommate assignments are based upon the dates of receipt, priority status and mutual request for one another. Residents are encouraged to submit their Agreements together. 3. The University makes all assignments without regard to race, sexual orientation, religion or national origin and rejects all requests for changes of assignments based upon these reasons. 4. The Resident agrees to observe the room change procedures established by the university and to have prior written approval before making a room change. 5. If a vacancy occurs in the assigned room, the remaining Resident agrees to: seek out another roommate; accept another roommate as assigned; move to another room if requested; or pay additional charges based upon lower occupancy of the room. 6. A resident may not sublease or rent a room assignment or permit another person to share a private room assignment. 7. The University reserves the right to modify room assignments for disciplinary reasons, catastrophe, closing of the facility or irresolvable roommate incompatibility. This Agreement may also be canceled by the University for disciplinary reasons. Students removed from University Housing for disciplinary reasons will remain obligated to the terms of this Agreement and any applicable fees. 8. If housing demand exceeds capacity, the University reserves the right to use temporary room assignments on campus. 9. If space is available, request for private rooms will be approved on a first-come, firstserve basis. The Resident of a private room agrees to pay the additional charges either before the semester begins or before the move is complete. VII. HOUSING FEE PAYMENTS 1. A Resident agrees to pay the full semester housing fee by the due date. 2. The Resident agrees that any deviation from the established schedule of payment or any problem with payment, must be approved by the office of Billings & Receivables before payment is due. 3. The Resident agrees that failure to make payment as prescribed does not relieve the Resident of accumulated housing fees while in residence. The Resident understands that nonpayment will result in denial of residence hall accommodations and services, as well as University registration, until the amounts due are paid. 4. Should a requested room change to another residence hall, which has a lower semester housing fee be approved, the Resident agrees that no housing fee refund will be made. VIII. CANCELLATION BEFORE THE BEGINNING OF THE ACADEMIC YEAR 1. A Resident who cancels this Agreement will receive a partial refund based on the following dates: 1. Cancellation received or postmarked by July 1 for an Agreement beginning Fall Semester or November 15 for Spring Semester, will receive a $100 refund.
2. Cancellation received or postmarked between July 2 and August 1 for an Agreement beginning Fall Semester or November 16 and December 15 for Spring Semester, will receive $50. 3. Cancellation received after August 1 for Fall or December 15 for Spring Semester received NO REFUND of deposit. 2. Written notice of cancellation must be made to the Department of Housing and Residence Life in order to receive a deposit refund. 3. A Resident who is denied admission will receive a full refund of the deposit when they cancel. 4. A Resident who does not receive a room assignment either permanent or temporary, before the beginning of the academic year, due to unavailable space, will receive a full refund of the deposit. IX. CANCELLATION AFTER THE BEGINNING OF THE ACADEMIC YEAR 1. A Resident who does not check into the assigned room by midnight of the first day of classes will be considered a "no show", and be canceled immediately. The housing deposit will not be refunded to no-show Residents. 2. Residents must go through the official withdrawal process to cancel this Agreement. Official withdrawal procedures are outlined in the University publication Hilltopics for Residence HaIl Living. The housing deposit will not be refunded to students who unofficially withdrawal. 3. A Cancellation Charge of $150, any applicable housing fees, and a $750 contract termination fee will be assessed to a Resident who officially withdraws from the residence hall at any time during the Academic Year and subsequently continues full-time enrollment. Exceptions to the Contract Termination Fee will be made for marriage, graduation, ineligibility to continue enrollment due to failure to meet academic requirements, or other circumstances which are determined by the University to be beyond the control of the student. Requests for Exception from the Contract Termination Fee along with appropriate documentation must be submitted to the Department of Housing and Residence Life. 4. A Resident's date of official withdrawal from the assigned residence hall room will determine the room charge and, if applicable, the amount of housing fee refund. 5. A Resident's housing fee charge will be $150 through the first week of the semester and thereafter be determined by the following schedule: Second Week: 50% of semester fee; Third Week: 25% of semester fee. After the third week, there is no refund of the semester fee. The refund amount will be the difference between the established housing fee charge and amount paid. 6. An assigned Resident who does not go through the official withdrawal process to cancel this Agreement on or before the last day of finals week of the Fall Semester will be considered an assigned Spring Semester Resident and will be charged a Spring Housing fee accordingly. X. POLICIES 1. The Resident agrees to become aware and observe all published policies affecting his/her status with the University. Specifically included in this Agreement by reference are the University publications Hilltopics for Residence Hall Living and the Student Handbook.
XI. FURNISHINGS, UTILITIES, and SANITATION 1. The University agrees to provide each resident with a bed, chest of drawers, closet space, desk, and a desk chair. An active phone jack, cable outlet, and data hookup are also provided in each room. 2. The University agrees to provide reasonable amounts of heat, water, electricity, and air-conditioning. Interruptions on a temporary basis for reasons of maintenance, repair or catastrophe will not be considered a breach of this Agreement and the University assumes no responsibility for damages such as food spoilage. If an interruption occurs, the University agrees to restore the affected service within a reasonable time. 3. The University agrees to provide trash removal from designated areas and to clean common hallways, baths, lounges, and general public areas on a regular basis. XII. CARE OF FACILITIES 1. The Resident agrees to be directly and financially responsible for keeping the room and its furnishings clean and free from damage, and to advise the hall director of any deteriorated conditions of the room or its furnishings. 2. The Resident agrees not to modify, or allow the modification of the assigned room or other parts of the building. The Resident agrees to obtain advance written permission from the Hall Director for painting, moving of additional furniture or constructing large extraneous structures. 3. The Resident agrees to pay charges for room damages, special housekeeping or maintenance services necessary due to misuse or abuse of facilities. 4. The Resident agrees to use public areas in a way that contributes to the orderliness and cleanliness of all areas used by Resident and guest. 5. The Resident agrees to report loss of the room key and to pay the charges for key and lock replacement. 6. The Resident agrees to check the smoke detector in the room once per month. 7. The Resident agrees to dispose of room trash in the designated areas. XII. LIABILITY 1. The University does not assume responsibility for the Resident's or other persons' loss of money or valuables, or for the loss of or damage to personal property and recommends that the Resident contact an insurance carrier concerning the availability of protection against such losses.
Transfer Form for Applicants Currently in the U.S.

INSTRUCTIONS TO APPLICANTS IN THE U.S.: All students should complete section A of this form. If you
ESLI at WKUs SEVIS School Code: NOL214F21308000 are on an F-1 or J-1 visa, you should request the International Students Advisor or counselor at the school you currently attend or most recently attended to complete Section B. You will not be issued an I-20 from ESLI at WKU until this form is completed and returned with the documents requested. Once you are issued and I-20 from ESLI at WKU, you must report to the Office of International Programs within 15 days of the beginning of classes to have your transfer processed. All forms should be sent to the address indicated on the back. FULLNAME_______________________________________________________________________________________ (Family or surname) (First or given name) (Middle name) SSN: ___________________________ COUNTRY OF CITIZENSHIP _______________________________________ SEVIS ID NUMBER _______________________________________________ SEMESTER OF INTENDED MAJOR FIELD ENROLLMENT AT WKU __________________ OF STUDY ___________________ MOST RECENT US INSTITUTION ATTENDED ________________________________________________ (Name of Institution) _________________________________________________ (Institutions SEVIS School Code) DEGREE SOUGHT________________
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - SECTION A: INFORMATION FURNISHED BY THE APPLICANT
DATES OF ATTENDANCE from____________to____________
Place and X next to the visa classification you now hold and attach copies of the documents requested. _____ F-1 Student: Attach copies of your I-94 (both sides) and all I-20s issued to you . _____ F-2 Dependent: Attach copies of your I-94 (both sides) and your spouses I-20 ID. _____ J-1 Student/Scholar: Attach copies of your I-94 (both sides) and all DS-2019s (IAP-66) issued to you. _____ J-2 Dependent: Attach copies of your I-94 (both sides) and all DS-2019s (IAP-66) issued to you. _____ L-2 Dependent: Attach copies of your I-94 (both sides). _____ H-1 Employee: Attach copies of your I-94 (both sides) and I-797 approval notice. _____ H-4 Dependent: Attach copies of your I-94 (both sides). _____ Other: Please specify and attach documentation (I-94, visa, approval notice, etc.)
I HEREBY AUTHORIZE THE INTERNATIONAL STUDENT ADVISOR AT THE U.S. INSTITUTION I HAVE MOST RECENTLY ATTENDED TO REVIEW THE INFORMATION PROVIDED ABOVE AND ON THE ATTACHED PHOTOCOPIED DOCUMENTS (S) AND TO PROVIDE THE ADDITIONAL COMMENTS REQUESTED IN SECTION B OF THIS FORM.
Signature ____________________________________________
(OVER)
SECTION B: ISA REPORT INSTRUCTIONS TO THE INTERNATIONAL STUDENT ADVISOR (ISA) AT THE INSTITUTION CURRENTLY OR MOST RECENTLY ATTENDED BY THE APPLICANT. Before filling out Section B, please review the information the applicant has provided in Section A against the records maintained in your office. Please answer the following questions and return the completed form to the address given at the bottom of this page. Thank you. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1. Is the information furnished in Section A (including photocopies of certificates of eligibility) complete and accurate according to records in your office? ____ YES ____NO (If NO, please comment)________________________________________________________________ ____________________________________________________________________________________ 2. 3. 4. To the best of your knowledge, is this student currently in status with the INS? ____YES ____NO Has the student ever been reinstated to status? _____ If yes, please indicate the date the reinstatement was approved: __________________________. If the applicant is in F-1 status, please indicate from your records his/her: First day of F-1 status _________________ INS Admission Number ____________________________ Dates attended at your institution: From ________________ To ___________________ Practical Training authorized by your institution (Please indicate type and specific dates): ____________________________________________________________________________________ ____________________________________________________________________________________ 5. If the applicant is in J-1 status, please indicate from your records his/her: First day of J-1 status _________________ INS Admission Number ____________________________ Name of Program Sponsor ______________________________________________________________ Program Sponsors SEVIS Program Number _______________________________________________ Academic Training Authorized (Specify Dates) _____________________________________________ 6. SEVIS Transfer-Out Date: _________________ - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Name and Title of ISA _______________________________________________________________________ Address __________________________________________________________________________________ Telephone ( ) ___________________________ Telefax ( ) ____________________________
Signature __________________________________________________
PLEASE RETURN THIS FORM AND ATTACHMENTS TO:
ESLI, WKU 1 Big Red Way, Bowling Green, KY 42101-3576 Fax: 270-745-7065
USA
CANADA
TEL: 360-724-0547 FAX: 360-724-0548

NAME OF STUDENT: __________________________________________________

Esli-Requisitos y Universidades

Diunggah oleh

Informasi Dokumen

Deskripsi Asli:

Judul Asli

Hak Cipta

Format Tersedia

Bagikan dokumen Ini

Bagikan atau Tanam Dokumen

Opsi Berbagi

Apakah menurut Anda dokumen ini bermanfaat?

Apakah konten ini tidak pantas?

Hak Cipta:

Format Tersedia

Esli-Requisitos y Universidades

Diunggah oleh

Hak Cipta:

Format Tersedia

USA

Trinity Western University Langley, British Columbia

TEL: 360-724-0547 FAX: 360-724-0548

ESLI Costs and Dates Trinity Western University Langley Campus

ESLI Course Fees & Calendar Fall 2010-Summer 2011

TRINITY WESTERN UNIVERSITY

9/7/2010 10/4/2010 12/17/2010

Tuition, Fees & Homestay 15 Weeks C$9,585

1/10/2011 2/11/2011 4/22/2011

5/2/2011 6/3/2011 8/12/2011

8/18/2010 10/1/2010 12/3/2010

1/18/2011 2/26/2011 4/29/2011

5/16/2011 6/6/2011 7/22/2011

ESLI Course Fees & Calendar Fall 2010-Summer 2011

MCNEESE STATE UNIVERSITY

1/24/2011 3/4/2011 5/13/2011

6/6/2011 7/1/2011 8/12/2011

MOREHEAD STATE UNIVERSITY

1/17/2011 1/28/2011 5/13/2011

6/6/2011 6/16/2011 8/5/2011

ESLI Course Fees & Calendar Fall 2010-Summer 2011

TEXAS A&M UNIVERSITY-CORPUS CHRISTI

1/10/2011 2/25/2011 5/6/2011

5/30/2011 6/24/2011 8/12/2011

UNIVERSITY OF SOUTHERN INDIANA

8/24/2010 10/4/2010 12/10/2010

1/5/2011 2/7/2011 4/29/2011

5/9/2011 5/31/2011 7/15/2011

ESLI Course Fees & Calendar Fall 2010-Summer 2011

WEST TEXAS A&M UNIVERSITY

8/30/2010 10/13/2010 12/10/2010

1/19/2011 3/9/2011 5/5/2011

6/1/2011 6/30/2011 8/11/2011

WESTERN KENTUCKY UNIVERSITY

8/23/2010 10/13/2010 12/17/2010

1/17/2011 3/4/2011 5/13/2011

6/6/2011 7/1/2011 8/12/2011

Trinity Western University

Academic English & University Entrance

AGENCY: ______________________________ COUNSELOR:___________________________ ADDRESS:______________________________ ________________________________________ CITY:______________COUNTRY:___________ TEL:_______________ FAX:________________ EMAIL:_________________________________

Trinity Western University

Married Date of Birth:

End Date: End Date: End Date:

Responsibilities of Membership in the Community of T.W.U.

Name: (please print) ____________________________________________

First and Middle: __________________________ Sex: ____ Male _____ Female

City: Country: Telephone: Email Address: Country of Citizenship:

_________________________ __________________________ __________________________ ___________________________

Tel No (daytime): ___________________________

_____ Independent _____ Talkative

_______________________________________ Date of Application:

Accepted Student Information Card

Name: ID# I will:

Miss Mrs. Ms. Mr.

Enrolling: live in residence

For Office Use Only:

Tel: ( Year entering: 1

) 2 3 yes 4 no New student Re-enrolling student Returning Student

Name: Address: City: Prov./State: Country: Postal/Zip Code:

Transfer student?: E-mail: Sex: male

female Student ID#:

Birth date (mm/dd/yy):

AGENCY: ________________ COUNSELOR:_ ADDRESS: ______________ CITY:COUNTRY:_ TEL:_ FAX: EMAIL:_______________________

First and Middle: ______________________ Sex: Male _ Female

_ ___

_ Independent _ Talkative

_ Student Signature _ Date Signed

Credit Card Holders Signature City, and Date

AGENCY: ________________ COUNSELOR:_ ADDRESS: ______________ CITY:COUNTRY:_ TEL:_ FAX: EMAIL:_______________________

Math_ Total Test Date____ [] Yes [] No

Name (print) _________________________________ Signature Date _

Health Care Providers Signature _________________________ DATE_

Date of Entry _/_

Date of Birth //__

Social Security Number ///--///--//// Undergraduate Professional __

IPV #1 // IPV #2 // OPV #3 // OPV #4 // #1 //__

Result: Reactive Non-reactive

Immunization (Combined hepatitis A and B vaccine) a. Dose #1 // b. Dose #2 //

Immunization (Combined hepatitis A and B vaccine) a. Dose #1 // b. Dose #2 //

Date // Result: Reactive _ Non-reactive ___

Date Read: //__

___________________ E-Mail address

Applicants direct-mailing addressESLI4528 Humphrey Hill Road___________________

Sedro Woolley, WA_98284____USA_

__

Signature ____________________________________________________________ Today's date