Youngstown State University - Center for International Studies

PLEASE TYPE OR PRINT ALL INFORMATION
( * Required to be completed)

Check the session you are applying for, and complete the year:

*(Name as written on passport)
*(Family Name)
*(First Name)
(Middle Name)
E-mail Address
*Telephone Number
Fax:

*Mailing Address (to where admission letter and I-20 should be sent).

(Address)
(City)
State/Province
(Postal Code)
(Country)

*Home Country Address (if different from above)

If same as 'Mailing Address' above, check this box:
Address:
City
State/Province
Postal Code
Country

Home Telephone Number (if different from above)
*Date of Birth (m/d/yyyy)
*Country of Birth
*Country of Citizenship
*Native Language

*Gender:

Male
Female

*Do you want university housing?

Yes
No

*What will your immigration status be? Check one:
F-I (Student)
F-2 (Dependent of F-1)
H (Temporary Worker/Trainee)
U.S. Permanent Resident or Citizen
Other (Please Explain)

*Do you have a U.S. Social Security number?
Yes
No

If yes, what is your social security number (example: 555-55-5555)?

Have you completed secondary school?
Yes
No

Have you graduated from a university/college degree program?

Yes
No

If yes, please indicate the following:
____
Two-year technical degree
Four-year undergraduate degree
Master’s/Ph.D. Degree
Other (explain):

Have you applied for admission to Youngstown State University?
Yes, as an Undergraduate Student
Yes, as a Graduate Student
No, but I plan to study at a university in the U.S.A.
No, I do not plan to study at a university in the U.S.A.

Are you transferring to the ELI at Youngstown State University from another school in the USA?
Yes
No (If you intend to transfer from another U.S. school, please send an official letter or transcript from the school with this application.)
Have you studied English before?
Yes
No

If yes, how long have you studied English? Write the number of years or months
Where have you taken classes in English? (Check all that apply.)
Middle School
High School
University/College
Other If other, please describe

Have you taken the TOEFL Test?
Yes
No

If yes, in what year did you take the TOEFL test?

What was your TOEFL Score?