APPLICATION FOR INTERNATIONAL STUDENT ADMISSION All items must be completed. Please TYPE in the spaces provided then print. 1. Please select your level and program Undergraduate studies: bachelor’s degree in Graduate studies: master’s degree in 2. Please select the start term (month and year) appropriate to your admission type: Intensive English Program: January March June August October year: Undergraduate or Graduate: Spring (January) Summer (May/June) Fall (August) year: Other: Please list date: Important: Please write your name EXACTLY as it appears in your passport. 3. Name Family Name/“Last Name” Date of Birth First Name/“Given Name”/“Personal Name” *Gender: Male Female Middle Name (if any) *Marital Status: Single Married Month/Day/Year City & Country of Birth Country of Citizenship 4. Permanent (Foreign) Home Address Street and Number Province/Prefecture/State City Postal Code Telephone Number Country Email Address Country Code, City Code and Phone Number Alternate Email Address Native Language _ 5. If dependents (spouse or children) will be coming with you, please complete the table below: Family Name/Last Given Name/First Date of Birth Country of Birth Relationship to Student 6. Express Mailing Address (if different from permanent address above) Street and Number Province/Prefecture/State City Postal Code Country Phone Number 7. Please provide contact information of immediate family member, in case of emergency Name Address 8. How did you learn about Gate Consult? Phone Number Relationship to You 9. Test scores Applicants please indicate what test(s) you have already taken and include score and date. TOEFL ACT GMAT IELTS PTE iTEP SAT GRE LSAT MCAT If other, please specify Month/Year Score Month/Year Score Month/Year Score Month/Year Score 10. If you are already in the United States, please mark one of the following: Visa Classification: Student (F); Exchange Visitor (J); Other (Please Specify) 11. Beginning with your secondary or high school education, list all schools you have attended (add pages as necessary): Name of School or Institution Location of School or Institution (City, Country) Type of School (High School, College, University etc.) Attendance Dates: (month/year to month/year) Your age at the end of study Name of degree, diploma, certificate & date received 12. Please read the following statements carefully and sign below: • I verify that all information submitted is complete and accurate. I understand that submitting false information could cause my admission to be denied, my acceptance to be cancelled or my suspension from Universities. • I will request all current and former educational institutions to send official transcripts or other information necessary for this application to the University. • I understand that information I provide on this application will be submitted to the Department of Homeland Security through the Student and Exchange Visitor Information System (SEVIS), as required by federal law. • I am aware that University health insurance is required unless a government or university sponsor can provide evidence of equal or greater health insurance coverage. If required, I understand that I will be charged for this policy automatically each academic year. Applicant’s Legal Signature Date 13. Affidavit of Support and Financial Verification (not required if separate affidavit page is included) I, (sponsor) a total sum of $ _, do swear that I will make available to (student) (U.S.) for each year of study. This money is in addition to any passage money needed for return to the country of origin. I understand that the University will not be able to assist the student financially. I, the undersigned, realize I am fully responsible and that I will be held accountable by the University for maintaining the terms of this statement. Sponsor’s relationship to student Sponsor’s Legal Signature Date Your sponsor must provide certified or validated bank statements to verify the above. You may sponsor yourself.