DE PAUL UNIVERSITY APPLICATION FOR exchange STUDENT ADMISSION DePaul University Exchange Student Checklist Instructions: Please submit your completed application packet to your Study Abroad Advisor on your home campus. Your advisor will forward your application and supporting documents to DePaul University s Exchange Coordinator on your behalf. Please note, your application will be considered incomplete and not eligible for admission if you are missing any of the items below. Use this checklist to ensure your application is complete. Admission Completed and signed DePaul University Exchange Student Application Official university transcripts Official English translations of university transcripts if not issued in English Proof of English language proficiency (TOEFL or IELTS Academic score) Immigration Copy of passport and ID page Affidavit of support form One bank statement or account standing on bank letterhead, no older than six months Translation of financial documents if not issued in English Mandatory health insurance information (required within 30 days of program start date) Enrollment Certificate of Immunity form (for students attending DePaul for more than one quarter)
application Instructions 1. Fees Students participating in an exchange program do not pay tuition to DePaul University. You are required to pay for your travel, living expenses, student fees and housing. * FEES TO BE PAID ON-SITE AT DEPAUL UNIVERSITY Students participating in an exchange program will be required to pay the following fees during their studies at DePaul University: Chicago Transportation Authority (CTA) University Pass Fee (You will receive a pass to be used for CTA trains and buses.) Lab Fees These fees are automatically charged to your student account at DePaul University and payments must be made every quarter. Information on payment options can be found at studentaccounts.depaul.edu. MANDATORY HEALTH INSURANCE COVERAGE for J-1 Exchange Students and Scholars It is your responsibility to obtain and maintain insurance coverage. U.S. government regulations require J-1 visa holders and their dependents to have adequate health insurance at all times that meet the following criteria: Medical benefits of at least $50,000 per accident or illness Repatriation of remains in the amount of $7,500 in the event of death Medical evacuation to your home country in the amount of $10,000 A deductible of no more than $500 per accident or illness Co-payment of medical expenses of no more than 25 percent Any insurance policy secured to fulfill the above requirements must be underwritten by an insurance corporation having An A.M. Best rating of A or above, or An Insurance Solvency International, Ltd. (ISI) rating of A-i or above, or A Standard and Poor s Claims-paying Ability rating of A or above, or A Weiss Research, Inc. rating of B+ or above or Such other rating service that the Exchange Visitor Program may specify from time to time. An Exchange Visitor who willfully fails to maintain the insurance coverage as set forth or who makes a material misrepresentation to the sponsor regarding the coverage will be considered to be in violation of the U.S. State Department regulations and will be subject to termination as an Exchange Visitor participant. HOUSING If you are admitted you will be contacted by DePaul s Exchange Coordinator about housing options. 2. Educational Credentials Submit official copies of your original post-secondary school records. These may include yearly transcripts, marksheets, exam results, final diplomas, degrees or graduation certificates. Course descriptions may be requested at a later date. Official copies are issued in the original language directly by your college or university. Copies must bear the official stamp and/or seal of the institution, as well as the signature of the appropriate official, such as the Dean, Rector, Registrar, Controller of Examinations or Office of Teaching Affairs. Photo/notarized copies or facsimile/ electronic mail transmissions will not be accepted. 3. English Translations Submit official translations of all educational documents originally issued in a language other than English. Official translations must be issued by a translation agency or university language department. The translation must be typed on official stationery, with the name, phone number and address of the translator. The translator must attest proficiency in the original language and must indicate that the translations are true and correct. Photo/notarized copies will not be accepted, nor will an evaluation of your education take place unless academic records are accompanied by true and complete, word-for-word translations. 4. Proof of English Language Competency All students educated outside of the U.S. must submit proof of English proficiency. A minimum TOEFL (Test of English as a Foreign Language) score of 80 (Internet-based test; no section lower than 17), 213 (computer-based test) or 550 (paper-based test) is required for all applicants, although some graduate programs may require higher minimum scores. Contact TOEFL directly (toefl.org) to request an official score report; DePaul s TOEFL code is 1165. DePaul also accepts an IELTS score of 6.5 or higher in place of the TOEFL. Please note that proof of English proficiency cannot be waived for any applicant educated in a country where the native language is not officially recognized as English. Waivers will not be granted to international applicants/non-native speakers on the basis of the following: education at a non-u.s. school where English was the language of instruction, U.S. employment or U.S. residency alone, completion of an ESL program alone. Proof of English proficiency may be waived (upon receipt of an official transcript) if an international applicant has completed the equivalent of DePaul s English 103 and 104 with a grade of C or better at an accredited U.S. institution. * Some exchange programs cover housing or provide grants to cover living expenses. Consult your Study Abroad Advisor if your program includes housing.
Application for exchange Student Admission Applicant Information (Please type or print clearly. Please list your name exactly as it appears on your passport.) Mr. Family Name Given Middle Ms. (Last) (First) Mrs. Former Last Name (if applicable) City and Country of Birth Date of Birth: (mm/dd/yyyy) Gender: Male Female Country of Citizenship Ethnicity (optional) Country of Permanent Residency Country of Permanent Residence Religious Affiliation (optional) Present Contact Information Street Address City, Country, Postal Code Home Telephone Country code city code phone number Email Address Mobile Telephone E Admission Information Admission requested for: Autumn Quarter (September) 20 Academic History Winter Quarter (January) 20 Dates of study: (mm/dd/yyyy to mm/dd/yyyy) Have you previously applied to DePaul? Yes Year from (Colleges and universities) No Spring Quarter (March/April) 20 to List below all educational institutions you have attended or are attending in order, beginning with Did the you most enroll? recent. Failure to list and provide Summer I Term (June) 20 transcripts for all previous colleges or universities attended may result in dismissal from DePaul or Yes ineligibility Year for graduation. Summer II Term (July) 20 No Name of Institution Date Program Began Exact Name of Diploma City and Country Date Program Ended Date Received Applying For: (check one) Undergraduate Graduate School of Music Applicants: College of Communication College of Communication Instrument The Richard H. Driehaus College of Business College of Liberal Arts and Social Sciences College of Liberal Arts and Social Sciences College of Education Voice and Range College of Computing and Digital Media (CDM) College of Computing and Digital Media (CDM) College of Science and Health College of Science and Health College of Education Kellstadt Graduate School of Business School of Music School of Music The Theatre School The Theatre School School for New Learning School for New Learning College of Law
Academic History (Colleges and universities) List below all colleges/universities you have attended after high school, beginning with the most recent. Failure to list and provide transcripts for all previous colleges or universities attended may result in dismissal from DePaul or ineligibility for graduation. Name of Institution Date Program Began Exact Name of Diploma City and Country Date Program Ended Date Received Test Results TOEFL Test Date IELTS Test Date Score Score Housing Information Do you wish to live on campus? Yes No Certification and Agreement to Sharing of Academic Records I wish to participate in the DePaul Exchange Program. I understand that by participating in this program, I agree to my home university and DePaul University sharing my academic records to facilitate the transfer of academic credits between the two schools. By signing below, I am giving DePaul University and my home university permission to exchange information about my academic record. This application must be signed by the applicant and is not valid if information is withheld or misinformation given. Any credit earned through an invalid application will be canceled. If admitted, the applicant agrees to comply with all rules and regulations of DePaul University. Applicant s signature Date
Immigration and financial matters Financial Documentation Students who plan to apply for J-1 student visa status are required by U.S. immigration law to submit evidence of adequate funding to meet the estimated living expenses for their duration of study before the DS-2019* form can be issued. Follow the steps below to submit evidence of adequate funding. 1. Please submit one bank statement, no older than six months, verifying the availability of funds for the required amount of $1,500 for each month that the student will spend in the United States. The bank statement or letter should clearly state the name of the account owner, the amount of money available, the currency, and the date when the document was issued. 2. If financial documents are not issued in English, please submit a word-for-word translation of all documents or submit the Translator s Affidavit contained in this application. Translation must be completed by a third party. Examples of an acceptable third party translator include a student, teacher, university staff member, bank staff member, or professional translator. The third party must sign any translation, attesting to its accuracy, or complete the Translator s Affidavit contained in this application. The translator may not be the student or the account holder listed on the bank statement. 3. If you are going to be sponsored, please request that your sponsor complete the enclosed Financial Affidavit of Support form. If you have more than one sponsor, each sponsor should fill out a separate form. If you sponsor yourself, you do not need to fill out the Affidavit of Support. Funds may be held in checking accounts, savings accounts, or short term investment accounts. Promissory notes, employer statements of estimated earnings, pension funds, and long term investment accounts may not be used to meet the financial requirements. The funds should be available to withdraw during the time that the student will be in the United States. Funds can come from multiple sources (different banks, or different bank accounts owned by the same sponsor, or even from multiple sponsors) but you must submit one bank statement or letter for each of these resources. Any false statements made regarding financial responsibility violate U.S. immigration laws. DePaul is not responsible if the amount of funds shown as available by the student or sponsor on the affidavit of support becomes unavailable after the date on this affidavit. Passport Copy All students requiring a DS-2019 from DePaul must submit a copy of the identification page of their passport with their financial documents. * DS-2019 is a certificate of eligibility issued by DePaul after you have been admitted. The DS-2019 allows you to apply for a J-1 student vis AFFIDAVIT OF SUPPORT As the financial sponsor of the individual named below, I hereby guarantee that he/she will not become a public charge while in the United States. I certify that I am able and commit to provide the minimum amount of USD $1,500 per month to cover living expenses for the duration of the individual s study at DePaul University. Student information Family Name (Last) First and Middle Relationship to Sponsor sponsor information Family Name (Last) First and Middle Street Address City, Country, Postal Code Signature of Sponsor Date
Translator s affidavit Date: I, the undersigned,, (translator name) (job title/position/organization) hereby certify that I speak English and fluently/well and (language of original document) that I have reviewed Mr./Ms. s attached financial statement issued (account holder name) by the in, (bank/institution name) (language of original document) dated / /. I certify that the attached financial statement refers to a checking / savings (mm/dd/yyyy) (select one) account number: and shows an ending balance of in. I attest that my translation of the attached financial statement, to the best of my ability, (currency of original document) is true and correct. (Printed Name) (Signature)
Certificate of Immunity STudent Information: Last Name First Name and Middle Initial Date of Birth (mm/dd/yy) DePaul Student # Email Address International Student? (F-1 or J-1 Visa) Yes No I authorize DePaul University to release this immunization record to the Illinois Department of Public Health or its designated representative for compliance audits or in the event of a health emergency. All immunization documents submitted to DePaul become the property of the University. I understand that, unless required to do so by law, DePaul University will not re-release my immunization documentation to me or any other academic institution or third party. Student Signature: Date: Please complete either Option A, Option B or Option C Option A: Attach a copy of you Official Immunization Records proving ALL immunizations. Skip Option B. Option B: See below Remainder of form to be completed and signed by physician or health care provider. Option C: Submission of additional information. Option B: To be completed and signed by physician or health care provider. Please note the following: Exemptions: The following will be accepted with an attached exemption form and supporting documentation Positive laboratory (serologic) evidence of immunity via blood (antibody) titer is acceptable proof for Measles, Mumps and Rubell Include all lab evidence with copy of lab report. Anyone with a vaccine exemption may be excluded from the college/university in the event of a Measles, Mumps, Rubella or Diphtheria outbreak in accordance with public health recommendations. All documents not in English must be accompanied by a certified translation. Medical/Pregnancy Exemptions Religious Exemptions Date of Birth Exemption Form - born before January 1st, 1957 TETANUS/DIPHTHERIA given within 10 years of attendance and every 10 years as adult, not less than 28 days apart. Note: International students are required to provide dates of 3 or more doses of Tetanus/Diphtheria vaccine. First Shot Date Second Shot Date Third Shot Date (required for intl students must be at least 6 months after 2nd shot) Fourth Shot Date (if applicable) MEASLES (Rubeola) 2 doses required, at least 28 days apart, after 12 months of age, given in 1968 or later. MUMPS 1 dose required, after 12 months of age. First Shot Date Second Shot Date oor diagnosis date oor positive blood titer with REQUIRED copy of lab report. First Shot Date Second Shot Date OR diagnosis date OR positive blood titer with REQUIRED copy of lab report. RUBELLA (German Measles) 1 dose required, after 12 months of age. First Shot Date Second Shot Date A history of Rubella is not acceptable evidence of immunity. oor positive blood titer with REQUIRED copy of lab report. Physician or public health official verification - I verify to the best of my knowledge that the above immunization information is correct. Physician Name (print or stamp) Physician s Phone # Physician s Signature: Date (mm/dd/yy) Fax: Fax: (312) 476-3200 This form must be completed and returned with applicable attachments before the student is allowed to register. To sumbit immunization records: In Person: DePaul Central Lincoln Park, SAC 101 DePaul Central Loop, DePaul Center 9th floor For more information please visit our website at sr.depaul.edu. Mail: DePaul University Attn: Student Records 1 E. Jackson Blvd. Chicago, IL 60604