The University of Utah
National Student Exchange Application
for the University of Utah and the Honors College
The University of Utah • National Student Exchange • 195 South Central Campus Drive • Salt Lake City, UT 84112 • 801-585-6423
Admission Deadlines
National Student Exchange Students
Term
Apply and complete application by
Spring 2015
October 22
Applications submitted with all required documentation will be accepted until November 15.
Summer 2015
March 15
Applications submitted with all required documentation will be accepted until April 1.
Fall 2015
April 1
Applications submitted with all required documentation will be accepted until July 1.
All required materials must be received by the application deadline for your application to be processed.
Note: Fees, deadlines, requirements, and enrollment limits are subject to change without notice. All documents submitted become
the property of the University of Utah, and will not be released to students nor forwarded to other institutions or agencies.
✔ Send all applications and supporting materials to:
National Student Exchange
195 South Central Campus Drive
Salt Lake City, UT 84112
Important Information
Your application will not be considered complete until you have submitted the following items: the application, non-refundable
$75.00 activity fee, unoffical transcript from home institution, and the signed Statement of Understanding.
Admission Information
Nondiscrimination
The University of Utah complies with all state and federal nondiscrimination and equal opportunity law. University of Utah admission
policies apply to all prospective exchange students without regard to race, color, religion, national origin, sex, age, status as a
disabled individual, sexual orientation, gender identity/expression and status as a protected veteran. The following University
employee has been designated to handle inquiries regarding the non-discrimination policies and grievance procedures: Manager,
Office of Equal Opportunity & Affirmative Action, 201 So. Presidents Circle, Rm 135, Salt Lake City, UT 84112, 801-581-8365 (voice/
tty), or online at www.oeo.utah.edu.
Accommodations for Students with Disabilities
The University complies with the Americans With Disabilities Amendments Act of 2008 (ADA) and Section 504 of the Rehabilitation
Act of 1973. Requests for accommodation or auxiliary services can be made by contacting: Director, Center for Disability Services,
200 S Central Campus Dr., Rm. 162, Salt Lake City, UT 84112, 801-581-5020 (voice), or online at disability.utah.edu.
Changing Your Admission Semester
The University of Utah will process your application for the semester specified on this form. To apply for a different semester,
you must submit a new NSE & admission application, additional application & activity fee, and updated transcripts.
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National Student Exchange Application
1.
*Indicates required fields.
Full Legal Name
*Last or Family/Surname
Middle Name
*First or Given Name
Other names under which your academic records may be listed:
Last or Family/Surname
*2. Date of birth (mm/dd/yyyy):
3.
Middle Name
First or Given Name
Preferred first name
U.S. Social Security Number
Privacy Act Notice: The University confidentially maintains your social security number for
routine uses such as facilitating document matching, verifying your identity, and expediting your
enrollment and financial aid. Disclosure of your social security number is voluntary. Failure to
provide your social security number may delay the processing of your application and once
admitted could result in delay or loss of federal and state financial aid, tax credits, student loan
deferments, veterans and other benefits provided by law.
Application Semester and Type
*4. Select the semester and year you plan to start/enroll
Spring 2015 (January)
5.
Summer 2015 (May)
Fall 2015 (August)
Check your payment plan
Plan A - The student pays the resident (in-state/in-province) tuition and mandatory fees of the University of Utah
directly to that campus.
Plan B - The student pays normal tuition and mandatory fees (e.g., health services, student activities) fees to their home
institution. That payment is retained by the home campus; it is not transferred to the University of Utah. Students do not
pay tuition to the University of Utah. Since Plan B students have paid their mandatory fees to their home university, they
are not expected to pay these fees to the University of Utah.
Whether using Plan A or Plan B, students are expected to pay fees which are assessed as a condition of enrollment in
courses (e.g., laboratory fees, internship, art and photography supplies, student teaching, field studies, activity fees). The
cost for room and meals are always paid directly by the student to their host campus, the University of Utah.
Participating campuses operate under one or both payment plans depending upon institutional, board, or state or
provincial policies governing reciprocity models.
If Returning Student
What is your uNID?
What was the last semester you were enrolled as a
degree seeking student at the University of Utah?
I have attended another institution since that time
I have not attended another institution since that time
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6.
If applicable, intended degree for which you are taking classes (select one only, see list of majors on page 12 of this application)
Degree Type
B.S. (Bachelor of Science)
B.A. (Bachelor of Arts, requires 16 semester hours of language credit)
B.F.A. (Bachelor of Fine Arts)
Undecided
Non-degree seeking (Non-matriculated)
Citizenship Information
7.
Country of Birth
*Country of Citizenship
8.
Non-citizens of the United States, provide the following information
Permanent Resident
Asylum or Refugee
International applicant on or requesting a visa
Utah high school graduate requesting Utah House Bill 144, 2002 consideration
Foreign national attending a Utah high school requesting House Bill 118 consideration
Other
If other, please specify
Contact Information
Directory information relating to a student is considered to be public information unless the student requests that it be kept
confidential. A form to restrict disclosure of directory information is available at the Registrar’s Office. Ten days are required to
process the request.
Directory information consists of: student’s name, address, telephone number, email address, student ID number, class standing,
major field of study, participation in officially recognized activities or sports, weight and height of members of athletic teams, dates of
attendance, degrees and awards received, most recent previous educational agency or institution attended, enrollment status, and
other similar information.
Applicant Contact Information
9. *Mailing address
City
State
Zipcode
Country
State
Zipcode
Country
Permanent/Home Country address
City
10. Phone numbers
Phone number
Phone number
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11. *Email address
We will use email as our primary means of contacting you throughout the admissions process. Provide us with an email
address which you check regularly and notify us immediately should this address change.
12. I am interested in more information about on campus housing
Single student housing
Family housing
Legal Residency Information
The Office of Admissions follows the state law, Utah Code 53B-8-102, “Definition of resident student” to determine your initial
residency classification. If you fail to complete all of these questions, you will be classified as a nonresident for tuition purposes.
Residents of Utah under the age of 25 must provide information about their parent or legal guardian. This information is required to
determine residency classification. Omission of all parent/guardian information will result in classification as a nonresident.
13.*Do you claim to be a legal resident
of Utah for in-state tuition purposes?
Are you currently living in Utah?
Yes
No
Yes
If yes, indicate how long you have currently
resided in the state of Utah without an absence
Less than 12 months
No
12 months to 24 months
24 months to 36 months
3 years or more
If you are a Utah resident, in which county do you reside?
*Do you have a valid driver’s license?
Yes
No
If yes, what state issued the driver’s license?
An American Indian, not otherwise qualified as a resident, shall be entitled to resident student status if he/she is enrolled on the
tribal rolls of a tribe whose reservation or trust lands lie partly or wholly within Utah or whose border is at any point contiguous
with the border of Utah. If applicable, indicate the American tribe which you are a registered member of
14. Parent Information
Mother/Guardian’s state of legal residence
Indicate how long your parent/guardian has currently
resided in the state of Utah without an absence
Father/Guardian’s state of legal residence
Indicate how long your parent/guardian has currently
resided in the state of Utah without an absence
Less than 12 months
Less than 12 months
12 months to 24 months
12 months to 24 months
24 months to 36 months
24 months to 36 months
3 years or more
3 years or more
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Family Information
All applicants are urged to respond to as many of the questions in this section as possible. Family information provides context for
better understanding of an applicant’s educational environment and circumstances. The information you provide in this section will
not put you at a disadvantage in the admission process.
15. Family member’s name
Relationship
Deceased
Street address
City
Zipcode
State
Phone
Country
Email
Is this person a University of Utah employee?
Is this person a University of Utah Alumnus(a)?
Yes
Yes
No
No
Level of Education
No High School
Two Year College Graduate
Some High School
Four Year College/University Graduate
High School Graduate
Post Graduate Study
Some College/University
16. Family member’s name
Relationship
Deceased
Street address
City
Zipcode
State
Phone
Country
Email
Is this person a University of Utah employee?
Is this person a University of Utah Alumnus(a)?
Yes
Yes
No
No
Level of Education
No High School
Two Year College Graduate
Some High School
Four Year College/University Graduate
High School Graduate
Post Graduate Study
Some College/University
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University of Utah Alumni Information
Non-resident undergraduate students only: If you want to be considered for the Alumni Non-Resident U Tradition Award and
Heritage Scholarship, complete the following for your parent who graduated from the University of Utah.
Parent name
Date of Birth (mm/dd/yyyy)
Degree
Graduation date (mm/dd/yyyy)
What city and state?
17. With whom do you currently reside?
Father
Mother
Both
Other
If other, please specify
18. Do you live in a single parent home?
Yes
No
19. Primary language spoken in the home
20. Extraordinary family obligations
Are you required to work to supplement the family income?
Do you serve as a primary caregiver for a family member(s)?
Yes
Yes
No
No
Optional Biographical Information
This information may be needed for federal reporting.
21. Gender
Male
Female
22. What is your first language?
23. Ethnic origin: choose what best describes you (optional)
Do you consider yourself to be Latino/a or Hispanic?
Yes
No
Regardless of your answer above select one or more of the following racial categories to describe yourself
American Indian or Alaska Native
Native Hawaiian or Pacific Islander
Asian
White
Black or African American
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24. Have you ever served in the U.S. Military?
If yes, list dates of military service:
Are you currently a member of the
Utah National Guard?
Yes
From (mm/dd/yyyy)
No
To (mm/dd/yyyy)
In what branch of the military did you serve?
Are you currently an immediate family member of someone who is a member of the
Utah National Guard?
Yes
Yes
No
No
Only Non-Citizens of the U.S. Complete this Section
Have you received your Permanent Resident Card?
Yes
No
If yes:
Permanent resident card number
Date issued (mm/dd/yyyy)
NOTE: Attach a copy of your permanent/resident alien card.
If no, please explain (500 characters maximum)
NOTE: Holders of Permanent Resident Cards are not automatically considered residents of the State of Utah for tuition
purposes. Please contact the National Student Exchange Office for further information and residency applications.
How long have you lived in the United States?
On what date did you enter the United States? (mm/dd/yyyy)
Years
Months
How long have you lived in Utah?
How long have you continuously resided in Utah? (mm/yyyy)
Years
Months
Where was you residence before coming to Utah?
Country
City
If you are currently on a visa or are requesting an I-20 Certificate of Eligibility from the University of Utah, complete the following:
25. Will you request the University of Utah to issue the I-20 Certificate of Eligibility?
Yes
No
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In order to issue the I-20 Certificate of Eligibility students must:
• Be accepted to the University of Utah as a degree-seeking student.
• Submit proof of financial responsibility.
If you currently hold an F-1 Visa, what school issued the I-20?
What date did you enter the United States (mm/dd/yyyy)?
What is your SEVIS Identification Number?
What date will you be released from your most recent school
(mm/dd/yyyy)?
Are you currently on OPT?
What is your U.S. International Identification Number (IIN)?
Yes
No
Do you plan to change to an F-1 student visa (if you now
have another type of visa)?
If yes, how will you change your visa status?
Leave, then re-enter the U.S.
Yes
Remain in the U.S. (this option may take 6+ months)
No
If you plan to bring your spouse and/or children and wish this information to be included on your I-20 Certificate of Eligibility, list them below:
Family Name
First Name
Middle Name
Date of Birth Country of Birth
Students currently holding the J-1 Exchange Visa should send a
copy of their DS-2019 with the rest of their application to:
Country of
Citizenship
Relationship
to Student
Gender
National Student Exchange
195 South Central Campus Drive
Salt Lake City, Utah 84112
Academic History
26. High School name
State
Was your diploma awarded on the
basis of home schooling?
Year will/did graduate
City
Country
If you do not plan to graduate from high school, have you
taken or plan to take the GED test?
Yes
Yes
No
No
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Enter your self-reported high school cumulative grade point average (GPA). It is important to report your GPA accurately, so we
suggest using the GPA listed on your transcript. Any discrepancies with your final transcript may result in the University of Utah
rescinding your offer of admission.
Students who have attended an international high school may enter an average score or leave this field blank.
Unweighted high school cumulative GPA
Scale
4.0
Other
27. You are NOT required to have official ACT or SAT test scores sent directly to the University of Utah from the testing agency.
Self-reported scores will be accepted for National Student Exchange application purposes.
Note: To meet the admission deadline, your admission application must be complete, including application, activity fee,
unofficial transcript, and signed Statement of Understanding.
ACT Composite test score
Date (mm/yyyy)
SAT test score (Math & Critical Reading Only)
Date (mm/yyyy)
28. Courses Planned (Optional)
This section may be completed to plan your course load during your exchange at the University of Utah. Your admission to the University
of Utah National Student Exchange Program will NOT be affected by whether you take the courses you list or not.
Future Courses
College/University Students - List below any courses you are considering to take during your exchange. Changing these
courses or registering for alternate courses will NOT affect your admission decision.
Course Department and Number
Course Title
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29. If you have experienced any extenuating circumstances that may have impacted your academic achievement, provide details
below (500 character maximum).
30. List, if any, in chronological order all the colleges you have taken courses from, including the University of Utah. An official
transcript(s) from each college you have taken courses from (except the U of U) must be mailed directly from the institution to
the Office of Admissions. Transcript(s) must be received before your application will be reviewed.
to list all institutions previously attended or degrees pursued may result in denial of admission, loss of credit or
Failure
dismissal from the University of Utah.
*List
status at each school using the following codes: G = Graduate, S = In good standing, P = On probation, D = Suspended or
dismissed, N = Non-matriculated or not seeking a degree
Name of Institution (Do not
abbreviate)
City and State or
Country
From
(mm/yy)
To
(mm/yy)
Name of Diploma
or Certificate Earned
Year of Graduation
(or expected date)
Status *
Honors College
The Honors College at the University of Utah is a place for highly motivated students to be involved in a community of excellence on
campus. Students participate in smaller classes, have great interactions with faculty, are expected to engage in and contribute to the
community around them, and graduate with an Honors degree after they have fulfilled Honors requirements.
31. Are you interested in applying to the Honors College?
Are you interested in pursuing a degree beyond a bachelors degree?
Yes
Yes
No
No
To be considered for acceptance into the Honors College students should have a grade point average of 3.5 or greater.
1.
rite, edit and proofread your essay in a separate word-processing program before attaching it to this application. We use a
W
holistic application review process, and your writing ability is no less important than your grades and scores.
2.
his is your opportunity to introduce yourself to us. Let us see who you are and what you are passionate about.
T
Demonstrate what qualities you would contribute to the Honors College. Be creative!
Essay Question (limit your response to 500 words)
Shakespeare wrote: “The fool doth think he is wise, but the wise man knows himself to be a fool”. What major lessons have
you learned in life and what do you hope to learn in college?
To be considered for the Honors College Priority Deadline, students must submit a complete application (including
transcripts and test scores, if applicable) to the University by November 1, 2014.
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Additional Comments
32. Provide any additional information that was not covered in the application that you feel should be considered.
(250 characters maximum)
All Applicants Must Carefully Read and Complete the Following Section
By submitting your application you certify that to the best of your knowledge, the information submitted on this application is accurate
and complete. You understand that if found to be otherwise, it is sufficient cause for refusal, rescission or dismissal. Any person
knowingly making a false or misleading statement is guilty of a Class B misdemeanor and is punishable pursuant to Utah Code
Annotated Section 76-8.504.
In addition, you must notify the National Student Exchange Office if any information provided in this application changes after
submission. You also acknowledge that the University of Utah, at its sole discretion, may verify any information submitted with your
application. You also consent to the release of your high school transcript or any other material relevant to an admission decision
to the University of Utah.
You also understand that if admitted, your admission is contingent upon your final credentials reflecting acdemic achievement similar
to the assessment at the time of your admission. If admitted, you agree to observe all the rules and regulations of the University of
Utah. You understand you will be responsible for payment of all amounts owed to either your home or host campus depending on
your chosen payment plan (including, but not limited to tuition, fees, fines, rents, and parking citations). You agree to make
payments promptly and that all payments will be applied to charges in the order determined by the University and also agree to pay
reasonable collection and/or attorney fees necessary to collect any outstanding balance on your account(s).
I understand that by submitting this application I certify that all information provided is accurate and true to the best of my
knowledge and I agree to the terms and conditions listed above.
Applicant Signature ____________________________________________________
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Date (mm/dd/yyyy)
NATIONAL STUDENT EXCHANGE
Undergraduate Academic Majors
The academic majors listed below are offered at the undergraduate level. If you have decided on a major, select it from the list
below and write it in the blank provided in question 6, page 3. If you have not decided on a major, write “undecided” in the
space provided. All new students are first enrolled in University College until they are admitted to a major.
Advisors in the University College will provide guidance to students in completing general education requirements and prerequisite
course work for their major. Transfer students who have completed most or all of their general education course work and are ready
for admission to the major must contact their program advisor as soon as possible. Undergraduates are expected to be accepted
into full academic major status by the end of their sophomore year.
Accounting1
Entrepreneurship1
Metallurgical Engineering
Anthropology
Environmental and Sustainability Studies
Middle East Studies
Applied Mathematics
Ethnic Studies
Mining Engineering
Architectural Studies1
Exercise and Sport Science
Art1, 2
Film and Media Arts
Music1,2
Art History
Finance
Nursing1
Asian Studies
French (Languages)
Parks, Recreation and Tourism
Athletic Training
Gender Studies
Peace and Conflict Studies
Atmospheric Sciences
Geography
2
Pharmacy1
Ballet1
Geological Engineering
Philosophy
Biology2
Geoscience
Physics2
Biomedical Engineering1
German (Languages)
Business Administration
Health Promotion and Education
1
Modern Dance1
2
Political Science
Psychology1
2
Chemical Engineering1
Health, Society and Policy
Religious Studies
Chemistry
History
Russian (Languages)
2
2
Chinese (Languages)
Human Development and Family Studies
Civil and Environmental Engineering1
Information Systems1
Classics (Languages)
International Studies
Communication1
Japanese (Languages)
Comparative Literature and
Cultural Studies
Languages
Computer Engineering1
Computer Science1
Earth Science Teaching Composite2
Economics
Electrical and Computer Engineering1
Elementary Education1
English
2
Latin American Studies
Linguistics
Management (Business)1
Marketing (Business) 1
Secondary Ed1 (must choose a
teaching major)
Social Work1
Sociology
Spanish (Languages)2
Special Education1
Speech and Hearing Science1
Theatre2
Undecided (not a major)
Materials Science and Engineering1
University Studies1
Mathematics2
Urban Planning
Mechanical Engineering1
Medical Laboratory Science1
1
This academic major has special admission requirements. Students should become familiar with specific admission requirements
by contacting the academic department during the first semester at the University.
2
Teaching major (or minor) is also offered in this field. If you plan to become a school teacher, check item 6 on the application. Also
contact the College of Education, Department of Teaching and Learning, 1705 E. Campus Center Dr., Rm. 142, Salt Lake City, UT
84112-9252, 801-581-7158.
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