Application for Graduate Study Related Files: Application Instructions Policy on Equal Opportunity

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1 Application for Study Related Files: Application Instructions Policy on Equal Opportunity Application Fee (Non-refundable): $45.00 (cashiers Check or money order) For Office Use Only IDENTIFICATION NUMBER PRINT OR TYPE (Use codes where indicated) SOCIAL SECURITY NUMBER: / / Application for (semester and year) Fall 20 Spring 20 Summer 20 Date of birth / / Month / Day / Year Gender (optional) [ ] Male [ ] Female Legal name [ ] Mr. [ ] Ms. Name: Last (family or surname) name First name Middle Previous last name(s) Permanent address: Number and street City: State/Country: Zip code: Mailing address: Same as Above Number and Street City: State/Country: Zip code: Day phone no.: _ Home phone no.: Fax no.: ( ) - [ ] U.S. citizen Citizenship [ ] Birthplace [ ] [ ] VISA Type [ ] Permanent resident U.S. State or Country U.S. State or Country Are you a veteran of the U.S. Uniformed Services? [ ] Yes [ ] No During Vietnam [ ] College/School [ AH ] C Codes Major [ PHTH ] C Codes Classification: [ ] Regular [ ] Unclassified (non-degree) Degree sought [ MPT ] D Codes Indicate specific program within the department Physical Therapy Status: [ ] New entrant [ ] Transfer [ ] FSR (Former student returning) Enrollment: [ ] Fulltime [ ] Part Time List all universities and colleges attended. List institutions where highest degree was obtained first. Howard University students: List Howard University and all other institutions.

2 Institution City State Country Major Degree received Dates From Mo/Yr To Mo/Yr Have you previously applied for admission to Howard University? [ ] Yes [ ] No If Yes, for which semester was last application submitted: Fall 20 Spring 20 Summer 20 Former Howard University students indicate last semester enrolled: Fall 20 Spring 20 Summer 20 Howard University school/college in which you were last enrolled: C Codes[ ] Major C Codes[ ] Howard University identification number (ID): NAME UNDER WHICH YOU LAST ATTENDED HOWARD UNIVERSITY IF DIFFERENT FROM NAME PRESENTLY USED. Last First If you answer yes to any of the next four (4) questions, attach a letter explaining details. MI a) Have you been arrested? [ ] Yes [ ] No b) Have you been convicted of any crime ( other than traffic violations ) or been sentenced to a correctional or penal Institution? [ ] Yes [ ] No c) Has disciplinary action been taken against you at any educational institution? [ ] Yes [ ] No d) Has academic action been taken against you at any educational institution attended? [ ] Yes [ ] No What most influenced your decision to attend Howard University? E Codes[ ] List family members (exclude spouse) who have attended Howard University. (optional) Name Relation Name Relation Name Relation Class of Class of Class of As indicated by my signature, I understand that withholding information required on this application or giving false information may make me ineligible for admission to the University or subject to dismissal when the same is made known regardless of classification. With this understanding, I certify that all of the above statements and information included are correct and complete; and, if admitted to Howard University, I agree to abide by its policies, rules and regulations. Signature of applicant Date Please return the completed form, $45 application fee check or money order made (payable to Howard University) and required

3 application materials directly to: Howard University Physical Therapy Department Division of Allied Health Sciences Sixth and Bryant Streets N.W. Washington, DC GS -Home Admission Program Special Program Financial Support Rules-and-Regulations Archives Feedback GS-Resources GS- Bulletin Search Howard University

4 Howard University Statement of Financial Resources Listed below are the estimated fees for international students at Howard University. Tuition and fees are shown below for the academic year only August May) and do not include the summer sessions. The living expenses shown are for a 12-month period. The figures are for the student and do not include spouses or children. When you complete the reverse side of this form, review carefully all the financial resources available to you to be sure that the total amount covers the expenses shown below for the school/college you wish to attend. You cannot depend upon employment to cover the costs of attending the university. Immigration laws allow students in good standing and who have been at Howard for at least two semesters to apply for off-campus employment. Applying for this work permit is very complicated. You may apply to the University for Financial Assistance after your first year of study at Howard, but you will compete for assistance with all other students who apply. In reviewing your financial situation, you should NOT count on either employment or financial aid from the University. To obtain a visa, you will have to present to the U.S. Embassy in your country evidence that you have financial resources to support yourself while studying in the United States. Funds for the entire first year of your studies must be immediately available, and you must have reasonable assurance that the funds will be available for subsequent years. COMPLETE THE REVERSE SIDE OF THIS FORM (if printing double sided), indicating the exact funds available to you and the sources of those funds. You and your sponsor must sign this form. If you have a scholarship from some source, attach an official letter which explains the terms of the award. This document must be current and not addresses to another college or university. General Undergraduate Allied Health Architecture Nursing Dental Hygiene (1 st Year) General Tuition and $10, , , , , , Fees Expenses 12, , , , , , Total 22, , , , , , Divinity Pharmacy Physical Therapy Law-J.D. Law L.L.M Medicine (1 st Year) Tuition and $11, , , , , , Fees Expenses 12, , , , , , Total 23, , , , , , Dentistry (1 st Year) Oral Surgery Orthodontic and Pediatric Dentistry Advanced Education in General Dentistry Tuition and Fees $20, , , , Expenses 15, , , , Total 36, , , , SUMMER SCHOOL: You are not required to attend summer school. If you decide to do so, you will pay tuition based on the number of credits you take. This tuition is in addition to amounts shown above for the academic year. FAMILY MEMBERS: You should calculate an additional $5,00 per pear in living expenses for your spouse and $3,000 per year for each child accompanying you.

5 * NOTE: This information is provided as a guide only and is not considered a contract or binding by the University. The University reserves the right to change tuition, fees, and other charges at any time. Name (Printed) Last (Surname) First Middle Initial School/College at Howard to which you are applying: Division: Undergraduate /Professional Medicine Dentistry Law **This form MUST BE accompanied by additional documentation as indicated below: Source of Funds Personal Funds Funds from Parents, Friends, and Relatives Scholarship/Loan Assistantships Acceptable Proof of Available Funds Bank Statements Letter indicating the exact amount of financial sponsorship to be provided. - and- Bank statement or other financial instruments indicating that the sponsor has available funds to meet the sponsorship commitment. Copy of award letter indicating the exact amount of the scholarship or loan. Personal Recommendation approved and signed by the President of the University. Bank statements and other financial instruments must be issued no earlier than 3 months prior to submission to Howard University. Sources of Financial Support (Amount available in U.S. Dollars) 1 St Year 2 nd Year 3 rd Year 4 th Year Personal Savings Parents and/or Sponsor Scholarship/Loan Other Total $24,500.00

6 All parents and sponsors who are financial sponsors must sign below to indicate acceptance of the financial responsibilities outlined above. Sponsor s Signature Signature Sponsor s Name Printed Name Printed Relationship to applicant Relationship to applicant Address Address Date Date Student s Signature (Name as it appears on all legal documents) Date N.B: Complete and return this form to: Howard University The Physical Therapy Department Division of Allied Health Sciences, Room B-14 Annex I 6 th and Bryant Streets N.W. Washington, DC This form is sent to all international applicants as soon as an application is received, and does not represent an offer of admission. The form I-20 is issued after admission has been granted and the completed financial statement form and enrollment fee of $ are received

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