Student Information

• *Date of Birth:
  example: January 25, 1985 = 01-25-85
• *Gender: Male Female
• Please type your name EXACTLY as it appears on your passport.
• *First (Given) Name:
• Middle Name:
• *Last (Family) Name:
• Current Mailing Address:
• *Street or P.O.Box:
• *City:
• State/Province:
• Post Code:
• *Country:
• *Telephone:
• Email Address:
• Verify Email Address:
• International Permanent Address (If different from current address):
• Street or P.O.Box:
• City:
• State/Province:
• Country:
• Post Code:
• Telephone:

Ethnicity (Optional)

• Are you Hispanic/Latino?: No, not Hispanic/Latino
  Yes, Hispanic/Latino
• Race:
  (Please choose
  one or more) American Indian or Alaska Native
  Asian
  Black or African American
  Native Hawaiian or Other Pacific Islander
  White

Dependents

• If you are bringing dependents (wife, husband or children) to the United States, please note the following information for each dependent:
1. given and family names (as appear on passport)
2. date of birth
3. country of birth
4. country of citizenship
   and
5. relationship to you

Citizenship

• *Country of Citizenship:
• *Country of Birth:
• *Are you a Permanent Resident of the U.S.? Yes No
• *Are you currently in the U.S. on a visa? Yes No
• If yes, what type:
  Please send a copy of visa and passport.

High School Education

• High School:
• *Name of your high school:
• *High School City:
• *High School Country:
• *Graduation Date:
• Please submit official/certified transcripts and/or examination results in their original language and with an English translation. (Uncertified photocopies are not sufficient.)

University Education

• *Have you attended a college or university? Yes No
• First University:
• Name of university attended:
• Dates of Enrollment:
• Degree Earned:
• City:
• Country:
• Second University:
• Name of university attended:
• Dates of Enrollment:
• Degree Earned:
• City:
• Country:
• Third University:
• Name of university attended:
• Dates of Enrollment:
• Degree Earned:
• City:
• Country:
• Please submit official/certified transcripts in their original language and with an English translation. (Uncertified photocopies are not sufficient.) For transfer credit consideration, please also order a course-by-course credential evaluation report from www.wes.org or www.ece.org for each college/university attended outside the United States.
• *Have you ever been on academic or social probation, suspended, expelled, or refused readmission to any college or university? Yes No
• If you answered "Yes," please explain:

Standardized Examinations

• Date I took/will take the SAT:
• Date I took/will take the ACT:
• Date I took/will take the TOEFL:
• Date I took/will take the IELTS:
• Please have official score results sent directly to the University of Indianapolis.

Enrollment

• New students are encouraged to enroll initially in August or January.
• *When do you want to enroll? June 2013
  August 2013
  January 2014
  May 2014
  
• *Enrollment: Full-time Part-time
• You must enroll full-time to maintain legal student visa status.
• *What do you want to study at the University of Indianapolis? Unable to connect to MS SQL Server