APPLICATION FORM COLUMBIA UNIVERSITY SCHOOL OF PROFESSIONAL STUDIES SECTION 1: Program of Studies: Program Choice: Undergraduate Visiting Student Graduate Visiting Student Summer Session Certificate Programs Term for which you are applying: Spring Summer Fall Year of commencement: Area of concentration (Postbaccalaureate applicants only): Applicant Information (as it appears on passport) First Name: Middle Name: Last Name: Date of Birth: Month: Day: Year: Sex: Male Female Place of Birth: Country of Birth: Country of Citizenship: Student Email: Page 1 of 8
Student s Current Address in Home Country Permanent Address: City: State/ Province: Country: Postal Code: International phone number: Good until: Student s Permanent Address in Home Country Permanent Address: City: State/ Province: Country: Postal Code: International phone number: Good until: Is English your first and native language, or was English the language of instruction at the college or university where you obtained your undergraduate degree, or where you are currently enrolled if your degree has not been conferred. If it is not English, what is your first/native language? What other languages do you speak? If your first or native language is not your first language but you consider English to be one of your primary languages, please respond to the following questions: If you were not born in the U.S., age at which you arrived in the U.S.? Page 2 of 8
What levels of schooling have you completed in which English was the sole medium of instruction (not including language courses): Elementary Middle School or Junior High High School College Are you interested in obtaining information about financing your studies? Please indicate how you heard about the program: Did you attend a live information session in person? Did you attend an online information session or webinar? SECTION 2: Emergency Contact Information Person to Contact in Case of Emergency: Relationship to Applicant: Current Address: City: Postal Code Country: Daytime International Telephone: Mobile/ Evening Telephone: Page 3 of 8
SECTION 3: Citizenship/ Visa Information Place of birth: (City, State, Country): If you are NOT a U.S. citizen, please provide the following information: Are you a permanent resident of the U.S.? If you are not a permanent resident, do you already hold a visa? If yes, what type? Visa Date: If no, what type of visa do you wish to apply? Duration in the U.S.: SECTION 4: Course plan (academic University Credit program) Please, list the courses you are planning to take (within your first term):. Course title 1. 2. 3. 4. Educational Background Please provide the following information on your educational history: What is the highest level of education you have obtained? Page 4 of 8
Please list the name of the school where each of your degrees was conferred: Degree Bachelor s Degree: Master s Degree: Ph.D./ MD: Institution: Has there been any significant interruption in your education or work? (please attach explanation) Have you been suspended or dismissed from another college? (please attach explanation) Have you ever applied to Columbia University before? Which division? When? Are you currently applying to another division of Columbia? Which division? Are you currently applying to other programs at another university? ( please list): University / institution 1. 2. 3. 4. Are you currently employed to Columbia University? Are you currently serving in the United States military? Page 5 of 8
Are you a U.S. veteran? SECTION 6: Employment History Total years of work experience: Industry: Job Category: Title /Position: SECTION 7: Educational Institutions Please provide the following information on the schools you have previously attended. Please list the undergraduate school where your bachelor s was conferred as Undergraduate School 1, and the graduate school where your masters was conferred as Graduate School 1. Undergraduate School 1 Name: Address: Dates: From (month/year): To (month/year): Grade Point Average (GPA): Currently enrolled: Type of Degree Granted: Area of Study: Date/Expected Date of Diploma: Undergraduate School 2 Name: Address: Page 6 of 8
Dates: From (month/year): To (month/year): Grade Point Average (GPA): Currently enrolled: Type of Degree Granted: Area of Study: Date/Expected Date of Diploma: Graduate School 1 Name: Address: Dates: From (month/year): To (month/year): Grade Point Average (GPA): Currently enrolled: Type of Degree Granted: Area of Study: Date/Expected Date of Diploma: SECTION 8: Self-reported Test Scores TOEFL Reading Listening Speaking Writing IELTS Reading Listening Speaking Writing DAAD Oral interaction Reading Writing Page 7 of 8
SECTION 9: Application Fee Currently, there is no application fee for IEC applicants. SECTION 10: Certification All applicants must sign below. I certify that the information I have provided on this application is complete and accurate. I understand that failure to disclose correct information may result in the cancellation of my application or admission. Important Reminder: Only complete applications will be reviewed. tification of admissions decision: Students are notified of admissions decisions via e- mail. Student Signature: Place, date (mm/dd/yyyy): SECTION 11: Authorization for IEC to process the application I hereby permit International Education Centre (IEC Online GmbH) to submit the information which I have provided on the Application Form of the Columbia University School of Professional Studies (STS) via an electronic online application form created and maintained by the STS. Student Signature: Place, date (mm/dd/yyyy): Please submit your application with all required documents to IEC: IEC Online GmbH Marienstrasse 19/20 D- 10117 Berlin Germany Page 8 of 8