APPLICATION FOR ADMISSION English as a Second Language Program and/or Undergraduate Study
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1 APPLICATION FOR ADMISSION English as a Second Language Program and/or Undergraduate Study For International Applicants Only Please print or type Leave shaded areas blank Total Fees Received Recipient Initials Receipt Date Application for: Year 20 Please check the boxes. The application fees listed are required and non-refundable. Undergraduate Program ($100 application fee) August January ESL Program ($100 application fee) August October January March June ESL and Undergraduate Programs ($150 application fee) August October January March June BIOGRAPHIC INFORMATION: Please respond to every question. Incomplete applications will be delayed. LEGAL NAME (AS IT APPEARS IN YOUR PASSPORT, PLEASE CIRCLE YOUR FAMILY NAME) BIRTHDATE (month/day/year) MAILING ADDRESS CITY PROVINCE POSTAL CODE COUNTRY GENDER Female Male ADDRESS (REQUIRED) TELEPHONE NUMBER COUNTRY OF BIRTH COUNTRY OF CITIZENSHIP ACADEMIC BACKGROUND & STUDY PLANS High school name, city, and country: What is your intended major? ALL APPLICANTS Month and year of high school graduation: UNDERGRADUATE APPLICANTS ONLY TOEFL or IELTS score: What is your expected length of study? ESL PROGRAM APPLICANTS ONLY one 8-week session three 8-week sessions two 8-week sessions four 8-week sessions REQUIRED ACADEMIC CREDENTIALS ESL Program applicants must furnish a certified and translated copy of their high school diploma/leaving certificate. Undergraduate Program and ESL and Undergraduate Programs applicants must furnish certified and translated copies of their high school transcripts (grade sheets) and their high school diplomas/leaving certificates. Undergraduate Program applicants must arrange for delivery of official TOEFL or IELTS scores. UWSP s ETS/TOEFL School Code for score delivery is REQUIRED FINANCIAL CERTIFICATIONS ESL Program applicants must complete the Financial Support Statement for UWSP English as a Second Language Program Students (page 2 of this document) and submit supporting bank/sponsor documents as indicated on page 2. Undergraduate Program and Undergraduate and ESL Programs applicants must complete the Financial Support Statement for UWSP Undergraduate International Students (page of this document 3) and submit supporting bank/sponsor documents as indicated on page 3. I certify that the information supplied by me in this application is correct and complete. I authorize the university to release information regarding my studies to my parent(s), sponsor(s) and my education agent (if applicable). I understand that the application and courier fees are required and non-refundable. Applicant Signature Date Signature of parent or sponsor if applicant is under 21 years of age Date Please send application form, academic credentials, financial documentation, and application fees to: UWSP Office of International Education 1108 Fremont St, 103 SSC Stevens Point, WI USA Telephone: +1 (715) Do you have questions about completing this application? If so, please contact us: isss@uwsp.edu
2 Financial Support Statement for UWSP English as a Second Language Program Applicants Estimated expenses for two sessions (16 weeks) of study during the academic year at the University of Wisconsin- Stevens Point are as follows (in USD): Tuition and Fees PLEASE NOTE: This is a relatively conservative budget for a student Campus Housing 2, Campus Meal Service 1, Insurance & Textbooks 1, Total $11, Please note: personal expenses are not included in this estimate who spends wisely and is willing to share on campus living quarters with another student. While some students may need less money, many students find that they spend more than this amount. This estimate does not include daily spending money, the cost of international travel, or keeping an automobile. Expenses may vary from estimates. All rates may change at any time. APPLICANTS ARE REQUIRED TO PROVIDE EVIDENCE OF FUNDS TO SUPPORT A MINIMUM OF TWO SESSIONS (16 WEEKS) OF STUDY. The minimum enrollment period is one 8-week session. Full payment for the first session of study & related charges is due upon arrival. Name of Applicant: Family Name Given Name Middle Name (if applicable) Session you plan to enter Year 20 Fall I (September) Fall II (October) Spring I (January) Spring II (March) Summer (June) Choose ONE: I will be self-supporting. (Please submit original bank statement* showing available funds of at least $11,170) I will be sponsored by one or more individuals. (Please have sponsor(s) complete form(s) and submit bank statements* totaling at least $11,170) I will be government-sponsored. (Please submit official documentation verifying government support) *An original bank statement is one on bank letterhead, with an official seal. We will accept faxed documents only if faxed directly from your bank or sponsor s bank. Your application for admission will not be considered unless both statements below are completed and supported by the requested official documentation. SPONSOR S STATEMENT I,, certify that I have read and understand the above financial support statement. I further certify that I have the financial resources to cover the expenses of the student,, in the amount of $ per year in addition for travel expenses for a round trip from the student s home to the University of Wisconsin-Stevens Point for each calendar year while this individual is in the United States. An original bank statement on bank letterhead reflecting a balance of at least this amount in U.S. currency is attached. I understand that the inclusion of any false information concerning financial support will be considered grounds for the student s dismissal from the University of Wisconsin-Stevens Point. Sponsor s Printed Name Sponsor s Signature Date Relationship to Student APPLICANT S STATEMENT I certify that all statements on this form are true and accurate, and that funds will be provided as specified above. I will notify the University of Wisconsin-Stevens Point of any changes in my financial circumstances or those of my sponsor. I understand that failure on my part or that of my sponsor to provide the needed funds regardless of prior admission and registration will result in the cancellation of my registration and my termination from the undergraduate program at the University of Wisconsin-Stevens Point. Student s Printed Name Student s Signature Date
3 Financial Support Statement for International UWSP Undergraduate Program Applicants Estimated expenses for nine (9) months of study during the academic year at the University of Wisconsin-Stevens Point are as follows (in USD): Tuition and fees (approximate) 16, PLEASE NOTE: This is a relatively conservative budget for a student Campus Housing 4, Campus Meal Service 3, Health & Accident Insurance 1, Total $25, who spends wisely and is willing to share on campus living quarters with another student. While some students may need less money, many students find that they spend more than this amount. This estimate does not include the cost of international travel or keeping an automobile. *Insurance premium for one calendar year: August 5, 2017 August 4, 2018 Expenses may vary from estimates. Official tuition rates are set in August. Name of Applicant: Family Name Given Name Middle Name (if applicable) Semester you plan to enter Fall (September) Spring (January) Year Choose ONE: I will be self-supporting. (Please submit original bank statement* showing available funds of at least $25,949) I will be sponsored by one or more individuals. (Please have sponsor(s) complete form(s) and submit bank statements* totaling at least $25,949) I will be government-sponsored. (Please submit official documentation verifying government support) *An original bank statement is one on bank letterhead, with an official seal. We will accept faxed documents only if faxed directly from your bank or the sponsor s bank. Your application for admission will not be considered unless both statements below are completed and supported by the requested official documentation. SPONSOR S STATEMENT I,, certify that I have read and understand the above financial support statement. I further certify that I have the financial resources to cover the expenses of the student,, in the amount of $ per year in addition for travel expenses for a round trip from the student s home to the University of Wisconsin-Stevens Point for each calendar year while this individual is in the United States. An original bank statement on bank letterhead reflecting a balance of at least this amount in U.S. currency is attached. I understand that the inclusion of any false information concerning financial support will be considered grounds for the student s dismissal from the University of Wisconsin-Stevens Point. Sponsor s Printed Name Sponsor s Signature Date Relationship to Student APPLICANT S STATEMENT I certify that all statements on this form are true and accurate, and that funds will be provided as specified above. I will notify the University of Wisconsin-Stevens Point of any changes in my financial circumstances or those of my sponsor. I understand that failure on my part or that of my sponsor to provide the needed funds regardless of prior admission and registration will result in the cancellation of my registration and my termination from the undergraduate program at the University of Wisconsin-Stevens Point. Student s Printed Name Student s Signature Date
4 UWSP Housing Policies & Room Assignment Questionnaire University regulations require all ESL Program and undergraduate students to stay in the residence halls (dormitories) unless they are over 21 years old, married, or third year undergraduate students. Room assignments for new students are in double (shared) rooms. Single rooms may be available after one semester of study. Single room assignments are based upon availability and resident seniority (length of time in the residence halls). There is an additional charge for a single room. Kindly answer the following questions. Your responses will assist the UWSP Office of Residential Living as they make your housing assignment: 1. Do you smoke? YES NO 2. Would you prefer to live on an alcohol-free floor? YES NO I understand that I must arrive at the University of Wisconsin Stevens Point prior to the start of the New Student Orientation Program and that I will be charged for housing during orientation week. I may check-in a few days before the start of orientation week and understand that such pre-orientation housing is also charged on a weekly basis. Campus food service will not be available until school begins. I will complete a regular UWSP Office of Residential Living housing contract during orientation. Your signature Date Month and Year of High School Graduation What is the best way for us to reach you? If we have questions about your application what is the best way to reach you? address Facebook profile WeChat ID Other Please send application form, academic credentials, financial documentation, and application fees to: UWSP Office of International Education 1108 Fremont St, 103 SSC Stevens Point, WI USA Telephone: +1 (715)
5 Credit Card Payment Form I,, hereby authorize UWSP to charge my credit card account in the amount of: $100 University Application Fee $150 English as a Second Language Program and University Application Fee $100 English as a Second Language Program only Application Fee $110 University Graduate Application Fee Type of Credit/Debit Card (circle one): VISA Master Card Discover Expiration Date: / Month Year Please complete this form and it to: isss@uwsp.edu Credit Card Holder s Full Name Student Name Credit Card Holder s Street Address Phone City Country Country Code or Zip Code / Card Number CV Code Month / Year of Card Expiration Date Signature Today s Date
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