Personal Information

Email: (Required)

Family Name:

First Name:

Middle Name:

Gender: ---MaleFemale

Street Address:

City:

State/Province:

Postal Code:

Country:

Telephone:

Fax:

Date of Birth: Month: Day: Year:

Country of Birth:

Citizenship:

Immigration Status:

Indicate your Immigration Status:
---Non-Immigrant (International Student)Permanent ResidentRefugee

If Non-Immigrant (International Student),
what is your expected visa type? (e.g. F-1, J-1, etc):

If Permanent Resident,
indicate Alien # or File #:

If Refugee,
what is the status you received?

Marshall Application Information

Starting Term: ---Fall 2011Spring 2012Summer 2012Fall 2012Spring 2013Summer 2013Fall 2013

Type of Student: ---Master'sDoctoralTransferTransient

If Transfer Student, give name of school:

Major:

Major Code: (List of Majors and Codes)

Emergency Contact

Name:

Address:

City:

State/Province:

Postal Code:

Country:

Telephone:

Email:

Relationship: ---ParentSpouseOther

If other, what is this person's relationship to you?

College Information

List all colleges or universities (including Marshall) you have attended prior to entering Marshall University.

1a. Name of School:
1b. City and State:
1c. Date Entered: Month: Year:
1d. Date Left: Month: Year:
1e. Degree Earned:

2a. Name of School:
2b. City and State:
2c. Date Entered: Month: Year:
2d. Date Left: Month: Year:
2e. Degree Earned:

3a. Name of School:
3b. City and State:
3c. Date Entered: Month: Year:
3d. Date Left: Year:
3e. Degree Earned:

Are you currently enrolled in the last institution listed above?  Yes No

Do you plan to graduate from your current institution?  Yes No

Have you ever applied to Marshall University before?  Yes No

Testing Information

Have you ever taken either of the following tests?

GRE  Yes No

GMAT  Yes No

Have you ever taken the Test of English as a Foreign Language (TOEFL)?  Yes No
If yes, when? Month: Year:
What was your TOEFL score?

Have you ever taken the Michigan Test of English Language Proficiency (MTELP)?  Yes No
If yes, when? Year:
What was your MTELP score?

Have you requested that the results of the tests taken
be forwarded to Marshall?  Yes No

Have you ever been enrolled in Marshall University's L.E.A.P. Intensive English Program?  Yes No

Dependent Information

Will your spouse accompany you?  Yes No

a. Name of Spouse:
b. Date of Birth: Month: Day: Year:
c. Country of Birth:

Will your children accompany you?  Yes No

1a. Name of Child:
1b. Date of Birth: Month: Day: Year:
1c. Country of Birth:
1d. Gender: ---MaleFemale

2a. Name of Child:
2b. Date of Birth: Month: Day: Year:
2c. Country of Birth:
2d. Gender: ---MaleFemale

3a. Name of Child:
3b. Date of Birth: Month: Day: Year:
3c. Country of Birth:
3d. Gender: ---MaleFemale

Website Survey

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Please provide any additional comments or suggestions to improve the site

I certify that all information which I have given on this form is true and correct. I understand that this application and all academic credentials must be on file in the Admissions Office at least two weeks prior to the beginning of the term for which I am applying, and that I must be formally admitted to the university before I will be issued a visa application document (I-20 or IAP-66). I further certify that I have read the general instructions in the Admissions Application. Providing false information can lead to non-acceptance, the nullification of credit and/or expulsion.

In Agreement: Your Name: