Personal Information

Email: (Required)

Family Name:

First Name:

Middle Name:

Gender: ---MaleFemale

Marital Status: ---MarriedSingle

Address:

City:

State/Province:

Postal Code:

Country:

Telephone:

Fax:

Date of Birth: Month: Day: Year:

Country of Birth:

Citizenship:

Immigration Status:

Are you NOW in the United States?  Yes No

If your answer is yes, when did you come to the United States? Month: Year:

What type of visa do you hold?

(Note: If you are transferring to the L.E.A.P. Program from a school in the United States, please send us a photocopy of the I-20 you currently hold)

If you are not in the United States at this moment,
do you wish to be sent an I-20 for a student Visa?  Yes No

If no, on which Visa do you intend to enter the United States?

Marshall Application Information

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

Type of Student: ---First Time FreshmanTransferExchangeTransient

If Transfer Student, give name of school:

College: ---College of BusinessCollege of Education and Human ServicesCollege of Fine ArtsCollege of Health ProfessionsCollege of Information Technology and EngineeringSchool of Journalism and Mass CommunicationsCollege of Liberal ArtsSchool of Extended EducationCollege of Science

Major:

Major Code: (List of Majors and Codes)

Are you being sponsored by an agency or embassy to study in the United States?
 Yes No

If yes, what is the name of the organization?

Where would you like to live while you study at Marshall? ---University DormitoryOff-Campus

Emergency Contact

Name:

Address:

City:

State/Province:

Postal Code:

Country:

Telephone:

Email:

Relationship: ---ParentSpouseOther

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

High School Information

High School Name:

City:

State/Province:

Country:

Graduation Year: Month:

Please write a brief statement of your activities since graduating from high school:

Past 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: Year:
1e. Degree Earned:

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

What is/was your career position in your home country?

Have you ever applied to Marshall University before?  Yes No

Testing Information

Have you ever taken either of the following tests?

ACT  Yes No

SAT  Yes No

Have you ever taken the Test of English as a Foreign Language (TOEFL)?  Yes No
If yes, when?  Yes No

Have you ever taken the IELTS?  Yes No
If yes, when?  Yes No

Have you requested that the results of the English proficiency 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

Applicant Survey

How did you learn about Marshall University?
 Friend or Relative
Name:
 Embassy or Consulate
Name:
 Advertisement
Name:
 Internet
Where on the internet?
 Other
Name:

How easy was this website to use and navigate? ---Very EasyEasyAverageHardVery Hard

Please provide any additional comments or suggestions to improve the site

Application Fee Payment Information

A $100 (US Dollar) application fee is required for all applications. A $50 (US Dollar) transfer evaluation fee is required for all TRANSFER students. Transfer evaluation fees are valid for one academic year. Once an undergraduate application fee has been paid, no additional application fee is required for subsequent applications (although express mailing fees may be required). All fees submitted to Marshall University are non-refundable. Listed fees are subject to change.

Signature

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 DS-2019). I further certify that I have read and agree to all policies and procedures as stated. Further, I understand that withholding or failing to provide accurate and complete information may result in administrative withdrawal, disciplinary action or prosecution by the University, and that I may be held responsible for payment of all fees. In consideration of my admission and enrollment, I, the undersigned, do hereby agree to assume and pay any and all costs and charges including interest, collection and reasonable attorney ’s fees for delinquent accounts.

In Agreement: Your Name: