International Student Application
2016-2017
Undergraduate
(conditional admission)
Undergraduate
ONLY
Select only one:
ESL
ONLY
Full Name:
(as on passport)
Family Name
Given Names
Home Country Address (required):
Other Address (agent or person in USA you allow to talk about this application.):
street
city
province
country
post code
Phone:
Phone:
E-Mail:
E-Mail:
Gender:
Marital
Status:
Male
Female
Date of Birth: (Month/Day/Year)
Single
Married
Country of Citizenship:
Place of Birth: (Country)
Religion (optional):
For which term are you applying?
(select one start date)
 Fall Semester
(August)
Which test have
you taken?
 2016
or
 2017
 TOEFL
 IELTS
 SAT/ACT
 none
Score
Date
What is your
How many years have
native language?
you studied English?
What will be your
 Summer Term
(May)
major area of study?
Please list all secondary schools, colleges and universities you have attended (including U.S. schools):
Name of School
City/Country
Dates of Attendance (start-end))
Name of Certificate
 Spring Semester
(January)
1.
2.
3.
I affirm that the information provided in this application is true and complete. I understand that providing false or misleading
information, or failing to provide material information, may be grounds for rejecting my application or for canceling my
enrollment. I authorize Capital to investigate all statements on this application and documents submitted in support of my
application. I authorize any reference, including any schools, colleges, or universities I have previously attended to provide to
Capital all academic and disciplinary information about me and I release them from all liability for providing such information.
Applicant’s Signature___________________________________
Date ________________
Month/Day/Year
Page 1 of 4
Housing intend survey: All undergraduate and ESL students under the age 22, or those who have completed few than 60
semester hours of prior university study, are required to live on campus unless living with a family member in Columbus.
Do you plan to live in a Capital University dormitory?
YES NO
Additional online housing application and agreement required and student must be officially admitted to Capital University
before they are eligible to apply housing online.
Are you already in the United States?
 Yes
 No
•
If you are in the USA now and your visa status is  Student (F-1) or  Exchange Visitor (J-1), then
complete the Capital University International Transfer Form.
•
If you are in the USA now but your visa status is NOT (F-1) or (J-1), what is your status?
List husband/wife and/or children COMING TO THE USA on an F-2/J-2 Visa:
Country
Country of
Family Name
Given Names
Date of Birth
(Month/Day/Year)
of Birth
Relationship
Citizenship
1.
2.
3.
4.
Who told you about
Capital University?
 Friend or Family who has lived in Columbus
 Capital University Employee or Student
 Study Abroad Agency:
Please send all application materials to:
Capital University
Office of Admission
1 College and Main
Columbus, Ohio 43209- 2394
U.S.A.
 Internet search
 Other:
Phone: (614) 236-7102
Fax:
(614) 236-7947
[email protected]
http://www.capital.edu/international
Page 2 of 4
Affidavit of Support
For I-20 (F-1 visa/status)
Student name: _______________________________________________________________________________
Sponsor name:
______________________________________________________________________________
Relationship (for example: Sponsor is the father, aunt, friend, etc.)
___________________________________________________________
Sponsor address: _____________________________________________________________________________
_____________________________________________________________________________
Sponsor telephone or e-mail:
___________________________________________________________________
Type of support (check one or both):
□
□
I promise that the amount of money indicated in any bank statement(s) submitted by me (now and in the
future) is available each year to the student, if necessary, for the ENTIRE PERIOD of study at Capital
University.
I promise that the student may live and eat in my Columbus-area home free of charge for the student’s
ENTIRE PERIOD of study at Capital University.
Sponsor Signature:
_______________________________________ Date __________________________
( Month / Day / Year )
For DS-2019 (J-1 visa/status) or I-20 (F-1 visa/status)
Financial Certification for Applicants Sponsored by a Government, Agency, or Organization
Each government, agency, or organization sponsoring a student should submit a letter (on official stationery) containing the following
information:
1. Name of sponsoring institution
2. Amount of support to be provided
3. Specification that support will be provided for studies at Capital University
4. Period of time for which support will be provided
5. Title and name of person signing the letter
6. Billing information (if appropriate)
Send Affidavit and Bank Statement(s) to:
Capital University
Office of Admission
1 College and Main
Columbus, Ohio 43209- 2394
U.S.A.
Phone: (614) 236-7102
Fax:
(614) 236-7947
[email protected]
http://www.capital.edu/international/
Page 3 of 4
International Student Transfer Eligibility Form
For students transferring to Capital University from another U.S. College, University or
ESL program.
To the Student:
Full Name: _________________________________________________________________________________________
(as on passport)
Family Name
Given Name
I authorize my International Advisor to provide the information requested below
Student Signature: _______________________________________ Date __________________________
To the International Advisor
This international student is applying to Capital University (school code: CLE214F10334000).
Please do not transfer out record to Capital University until the student has received a Capital acceptance
letter.
Is the student in legal F-1 or J-1 immigration status: YES ______ No______
If not, when was the student’s SEVIS record terminated? ___________________________________________
Is the student is good academic and disciplinary standing at your institution? YES ______ No______
If not, please explain ________________________________________________________________________
Start date at your school ________________________Latest vacation term (if any)_________________________
Dates of any medical leave at your school__________________________________________________________
Does the student have any outstanding financial obligations to your school? YES ______ No______
Has the student been granted permission for practical training? YES ______ No______
If so, dates of : Curricular full-time ___________________part-time _____________
Optional
full-time __________________ part-time______________
Has the student been recommended to USCIS for employment based on economic hardship? YES ____ No______
If yes, please explain ________________________________________________________________________
If student holds a J-1 exchange visitor visa, who is the sponsor? ________________________________________
Program Number ___________________________ Category________________________________________
International Student Advisor:
____________________________________________________________________________________________
Signature and Date
Print Name
E-mail or telephone
Please fax or email this form to:
Name and the Address of transfer out Institution
Capital University
Office of Admission
1 College and Main
Columbus, OH 43209-2394
FAX: 614-2367947
Phone: 614-2367102
Email: [email protected]
Page 4 of 4