California State University Stanislaus
Office of International Education (OIE)
United States of America
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INTERNATIONAL STUDENT APPLICATION FOR ADMISSION
Term applying for: 20 _____ Major: __________________________ Applying as:
Fall (Aug.-Dec.) Degree: ___________________________
Spring ( Jan.-May) Code: ___________________________
Summer ( June-July)
Bachelor’s Degree
Doctoral Degree/Ed.D.
Master’s Degree
International First-Time Freshman
International Transfer Student
International Graduate Student
English Language Program
Intensive English as a Second Language Program
Name: (Print your name clearly, exactly as it appears on your passport and/or legal documents.)
____________________________________ / ____________________ / _________________________
Surname/Family Name/Last NameGiven Name/First NameMiddle Name
Date of Birth: __ __ / __ __ / __ __ __ __ Gender:
Male Female U.S. SSN __ __ __ - __ __ - __ __ __ __
Month
DateYear(leave
blank if you do not have)
Place of Birth:__________________________________Country of Citizenship: ___________________________
CityCountry
Country of Legal Permanent Residence: ______________________________________________________________
_________________________________________________________________
Current Mailing Address:
(Do not use U.S. addresses if you
_________________________________________________________________
do not presently reside in the U.S.) _________________________________________________________________
CityState/ProvinceCountryPostal/Zip Code
Email _______________ Cell Phone _______________ Telephone _______________ Fax _______________
________________________________________________________________
Permanent Address:
(Required for I-20/DS-2019 regard- ________________________________________________________________
less of current mailing address)
________________________________________________________________
________________________________________________________________
CityState/ProvinceCountryPostal/Zip Code
Email _______________ Cell Phone _______________ Telephone _______________ Fax _______________
If admitted, the student will be considered for the following scholarships: (Official Use Only)
1.
2.
3.
________________________________ _________________________ ____________________________
MAHMOUD LAMADANIECityCountry
Director, Office of International Education
Date: _______________________
Are you a United States citizen?
Yes No
If you are currently in the U.S., indicate what type of visa you hold. Please attach copies of visa and I-94 (front and back)
Visa type requested
0F-1
0J-1
What is your native language? ______________________________________________________________________
Have you previously applied to CSU Stanislaus?
Yes
No When? ____________________
Have you been enrolled at CSU Stanislaus?
Yes
No When? ____________________
Special Needs
Yes
No Please attach description
Official Admission Test Score Report: (ACT/SAT/GRE*/GMAT*)
* If applicable – required by certain graduate programs
INSTITUTION CODE:
4713
Have you taken TOEFL/IELTS?
Yes
No When? __ __ / __ __ / __ __ __ __ Score: ______________
Have you taken ACT?
Yes
No When? __ __ / __ __ / __ __ __ __ Score: ______________
Have you taken SAT?
Yes
No When? __ __ / __ __ / __ __ __ __ Score: ______________
Have you taken GRE?
Yes
No When? __ __ / __ __ / __ __ __ __ Score: ______________
Have you taken GMAT?
Yes
No When? __ __ / __ __ / __ __ __ __ Score: ______________
Be sure to request that official test scores are sent to the university. Use the above California State University, Stanislaus
institution code for official score reporting.
For more information on how to send your official score reports, please visit www.ets.org.
The International Student Application Fee is U.S. $55. Payment method:
Enclose a bank draft on a U.S. bank, a personal check, or a money order payable to California State University, Stanislaus
(non-refundable).
Applications received without the appropriate fee will not be processed
DO NOT SEND CASH
Official Statement of Finances
All students who are, or will be, on F-1 or J-1 visas must complete this section. In order to issue you a visa document to
enter or remain in the United States, CSU Stanislaus must be assured you will have sufficient funds available to meet all
tuition and living expenses for the duration of your studies. The university has limited scholarships for foreign students.
Health insurance is required for all F-1 or J-1 students on non-immigrant visas. Health insurance may be purchased for
F-2 dependents and is required of all J-2 dependents accompanying the student to CSU Stanislaus.
Sources of Financial Support
Please refer to www.CSUSTAN.edu/OIE for the yearly estimated expenses.
Personal Funds of the student. Attach a recent original bank official’s letter or bank statement verifying the total
necessary funds that are on deposit.
Family Funds Name of the family member
Relationship
Attach an original Affidavit of Support from the sponsor specifying the amount and duration of the support for
attendance at CSU Stanislaus. Attach an original bank letter verifying that the first year’s funds are currently on
deposit and that the sponsor has sufficient funds in the amount indicated.
U.S. Sponsor
Name of the U.S. sponsor
Attach an original Affidavit of Support from the sponsor specifying the amount and duration of the support for
attendance at the university. Attach an original bank letter verifying that the first year’s funds are currently on
deposit and that the sponsor has sufficient funds in the amount indicated.
Government Agency or Employer
Name of the government agency or employer
Attach a letter from the sponsor stating the amount and duration of the scholarship and validity for attendance
at CSU Stanislaus.
Dependent Information
Number of family members who will be living with you while you pursue your degree program. You must show additional
funds of $7,000 for your spouse and $5,500 for each child to cover expenses and insurance cost. If more than three children,
attach information on a separate page.
Surname/Last/Family
Name
First/Given
Name
Middle
Name
Date of
Birth
Gender
Birth City
Birth Country
Citizenship
Country
Relationship
(Spouse/Child)
Educational Data
Please list all secondary schools and universities attended on the back page. List each year separately.
Column 1
Column 2
Column 3
Column 4
Column 5
Column 6
Column 7
Fill in the calendar years. Write the appropriate months/years for every school.
List your age during the first year for each place of study.
This represents the actual years you attended school.
List the type of school attended (e.g., university, college, secondary school).
List each class level (e.g., grade standard, form, class sixieme, conquieme, sextra, quita) you completed in your
years of attendance at that school.
Print clearly the full name, city and country of each school/college/university, including secondary school.
Write the name of any examination(s) you passed or certificate(s) you obtained at the end of that school year.
Continued on next page
For example, if you completed secondary school at the close of your 12th year in school, on that line write “G.C.S.,” “Reifezeugniss,”
“Studentereksamon,” “Bachillerato,” “Artium,” “Baccalaureate II,” etc.(using the terminology of the educational system).
Secondary School
1
2
3
4
5
6
7
Calendar Month(s)/
Year(s) (From-To)
Age
Number
of Years
Attended
Type of
School
Grade(s)/
Level(s)
Name of School, City, Country
Certificates Degrees/
Diplomas
EXAMPLE
9/09-6/10
18
1
Secondary
School
12
Tokyo Secondary School
Tokyo, Japan
Katogakka Sotsusyu
Shomeisho
University (if you are applying as a transfer student, you must complete this section.)
1
2
3
4
5
6
7
Calendar Month(s)/
Year(s) (From-To)
Age
Number
of Years
Attended
Type of
School
Grade(s)/
Level(s)
Name of School, City, Country
Certificates Degrees/
Diplomas
EXAMPLE
8/08-4/12
21
4
Tokyo Secondary School
Tokyo, Japan
B.S.
University Undergrad
Declaration
I hereby certify that the information provided by me in this application and any attached materials is correct and complete.
I also certify that it is my sole responsibility to abide by all U.S. immigration laws and visa regulations. I affirm that I
have, at my disposal, enough financial resources to pay fully for all my school fees and expenses at the time of registration.
I agree to abide by all the rules and regulations of the university. If accepted into the ESL program, I must complete my
required courses prior to starting academic studies unless stated otherwise on my admission documents or unless the
Director of OIE grants a written waiver. If the applicant is under 18 years of age, a parent or legal guardian must also sign
this statement. All application materials become the property of the university and cannot be returned. I understand that
estimated tuition, fees and expenses are subject to change with or without notice.
Applicant’s Signature
Date
If under 18 years old:
Parent/Guardian’s Signature
Date