Office of Study Abroad - Center for Global Education
Transcription
Office of Study Abroad - Center for Global Education
Print Form Office of Study Abroad Tulane University, 7008 Zimple Street, New Orleans, LA 70118, USA Phone: (504) 865-5339 Fax: (504) 862-8765 CIS Exchange Student Application [email protected] Student Information PLEASE PRINT CLEARLY. FILL OUT AND TURN IN THE COMPLETED APPLICATION TO THE INTERNATIONAL OFFICE AT YOUR HOME UNIVERSITY. Student name (Last/Family Name, First Name, Middle Name, Jr., etc.) _____________________________________________________________________________________________ Prefer to be called: __________________________________ Male Female Please check here to indicate your Home University. Universidad de Belgrano, Buenos Aires, Argentina Université Claude Bernard, Lyon 1, France Université Lumière, Lyon 2, France Université Paris Sorbonne – Paris IV, France Brandenburg Technical University of Cottbus, Germany Darmstadt University of Technology, Darmstadt, Germany Friedrich-Schiller-Universität, Jena, Germany University of Hamburg, Germany Universidad Francisco Marroquin, Guatemala University of Malta, Msida, Malta Royal Holloway University of London, UK University of East Anglia, Norwich, UK University of Sussex, Brighton, UK I am applying to Tulane University for: I plan to begin in: One Semester Fall 200__ Full academic year Spring 200__ Area(s) of academic interest / Main subject / Major: _____________________________________________________________________________________________ _____________________________________________________________________________________________ Coursework you wish to pursue at Tulane University: _____________________________________________________________________________________________ _____________________________________________________________________________________________ Permanent address (number and street, city or town, ZIP / post code, country): _____________________________________________________________________________________________ _____________________________________________________________________________________________ Mailing address (if different) (number and street, city or town, ZIP / post code, country) _____________________________________________________________________________________________ _____________________________________________________________________________________________ Use mailing address until (date): __________________________________________________________________ Permanent home telephone (country code - area code - number): _______________________________________ Current telephone (if different) (country code - area code - number): ____________________________________ E-mail address: ________________________________________________________________________________ Date of birth (month - day - year):_________________________________________________________________ City of birth, Country of birth:___________________________________________________________________ Country of Citizenship: _________________________________________________________________________ If you are a dual citizen, please indicate which passport you will use to apply for your student visa. 1 Emergency Contact Information Father's name: ________________________________________________________________________________ Home address (if different from yours) (number and street, city or town, ZIP / post code, country) _____________________________________________________________________________________________ _____________________________________________________________________________________________ Home telephone:____________________________ Business telephone:________________________________ Fax: ____________________________________ E-mail address:______________________________________ Mother's name: _______________________________________________________________________________ Home address (if different from yours) (number and street, city or town, ZIP / post code, country) _____________________________________________________________________________________________ _____________________________________________________________________________________________ Home telephone: ____________________________ Business telephone:________________________________ Fax: ____________________________________ E-mail address:_______________________________________ My parents are: Married Divorced Separated Emergency contact information if different from the information above: Name:____________________________________ Relationship to you:________________________________ Home address (if different from yours) (number and street, city or town, ZIP / post code, country) _____________________________________________________________________________________________ _____________________________________________________________________________________________ Home telephone:____________________________ Business telephone:________________________________ Fax: ____________________________________ E-mail address:_______________________________________ Academic Information Name and address of home university (street address, city or town, Zip / post code, country): _____________________________________________________________________________________________ _____________________________________________________________________________________________ List courses you are taking now at your home university: _____________________________________________________________________________________________ _____________________________________________________________________________________________ On a separate sheet, list all courses you have taken. Include course title, final grade, or attach a copy of your official school listing. Also send an Official Transcript from your home institution to Tulane University as soon as possible. Essay (required) Write a personal statement that will help us learn more about you as an individual and provide us with information that is different from courses, grades and other objective data. Use separate sheets of paper to write a one- to twopage essay, answering these questions in detail: Why do you want to study in the United States? Why did you choose Tulane University? What do you wish to study? What non-academic experiences would you like to have while studying at Tulane (e.g. meet new people, get to know the American culture, or the "Southern Culture", experience life at an American university…)? How do you think the experience of study at Tulane will benefit you in the future? Finally, describe some of your special interests, significant experiences or achievements. Make sure your name is on each page. 2 Personal Responsibility Statement If you check any of the boxes below, please explain the circumstances in detail on a separate sheet. If, after you have submitted this form, new circumstances change your status or would cause you to check any of the boxes below, you must notify us as soon as possible. Check here if you have ever left a school voluntarily for an extended period of time. Check here if you have ever been placed on probation, suspended or expelled from any school. Check here if you have ever been convicted of a crime. Signature My signature below indicates that the information in my application is complete, factually correct, and honestly presented. _____________________________________________________________________________________________ Date Signature 3 Declaration and Certification of Finances Important Note: Tulane University will not issue an DS-2019 Certificate Of Eligibility, which is essential to obtain a United States visa, until all three parts of the Declaration and Certification of Finances (DCF) have been completed and the information and the Official Certification of Sources and Amounts has been returned to the Center of International Studies. Declaration and Certification of Finances The purpose of this form is to certify that you will have the approximately $11,000 per year necessary to support yourself during the academic year (this amount changes every year according to price changes). The information provided on the Declaration and Certification of Finances form must be true and accurate. The inclusion of false information is grounds for dismissal in the United States. Please be aware that a student visa does not permit international students to work off campus in the United States. 1. Student information for DCF Student name (last / family name, first name, middle name, Jr., etc.): _____________________________________________________________________________________________ On the line above, please circle the name by which we should file your credentials at Tulane. Current mailing address (number and street, city or town, ZIP / post code, country): Permanent home telephone (country code - area code - number): ________________________________________ Current telephone (if different) (country code - area code - number):______________________________________ Fax:______________________________________ E-Mail address: ____________________________________ For how long do you plan on studying at Tulane University (check one)? One semester One academic year 2. Financial Information Can you pay for your round-trip travel to the United States? Yes No Please indicate below how much you or your family will be able to contribute to each of the costs of attending Tulane University for one year. If you will be using a scholarship or financial aid from a government or organization, please attach a letter from them detailing your scholarship or financial aid. Estimate of International Student Expenses. 2008-2009 academic year (August - May) Student/Family contribution per year Tuition and Fees $37,500 Waived Room $5,200 $_____ Books and Supplies $900 $_____ Board $3,196 $_____ Personal Expenditures (clothes, laundry, etc.) TBD $_____ Medical Insurance $1,130 $_____ ______________________________________ Total $41,828 _______________________ Total *$10,618 *This figure must indicate the amount of money, in U.S. dollars, that you will have available per year for your use while in the United States. Consider applicable exchange and currency regulations in your figures. 4 3. Official Certification of Sources of Funds and Amounts This is to certify that I (Bank Official) have read the information furnished by the applicant on this form, that it is a true and accurate statement, and that the funds are available. _____________________________________________________________________________________________ Date Bank official's signature Name of bank:_________________________________________________________________________________ Address of bank:_______________________________________________________________________________ I (applicant) understand that inclusion of false information above is grounds for dismissal from Tulane University, and I attest by my signature that it is factually correct and honestly presented. _____________________________________________________________________________________________ Date Signature of student _____________________________________________________________________________________________ Date Signature of guarantor Address of guarantor:___________________________________________________________________________ 5 Statement of Good Standing / Recommendation (by International Office at Home University) Student name (last / family name, first fame, middle name, Jr., etc): _____________________________________________________________________________________________ The student named above, who has attended your institution, is applying for admission to Tulane University. Would you please provide the information requested below and include this form with the student-application? We are interested in the non-academic aspects of the student's stay at your institution, as well as the academic. Thank you. Would you recommend the applicant? Please check the appropriate box: Yes With reservation No Please provide additional comments, and if the information is available, we would appreciate your comments on the applicant's behavior and conduct while attending your institution. _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ Signature ___________________________________________________________________________________________ Signature ___________________________________________________________________________________________ Date Print name and title 6