International Student
Application for Admission
163 Stormont Street • New Concord • Ohio • 43762 • USA
Ph: +1-740-826-8127 Fax: +1-740-826-6113
Please type or print clearly in English. Before sending this application, be sure to complete all sections, and include the following:
1. Completed application form with signatures;
2. An official high school transcript and university transcript if applicable, sent in an envelope sealed and stamped over the seal by the
issuing institution;
3. 2 or more letters of recommendation, from a teacher, professor, or school administrator;
4. An essay, at least 500 words in length, in English, written in your own hand (not typed);
5. Proof of English proficiency and any school leaving test reports; and
6. Certified bank letter and other evidence of financial support demonstrating your ability to finance your first year’s tuition and
expenses. Documentation may not be more than three months old.
Part A. Personal & Family Information
Mr
Ms._________________________________________________________________________________
Family/Last Name Given/First Middle or Maiden
__________________________________________________________________________________________
Present Address Number and Street Town/City
__________________________________________________________________________________________
State/Province Country Postal Code
__________________________________________________________________________________________
Permanent Home Address (if different from above) Number and Street Town/City
__________________________________________________________________________________________
State/Province Country Postal Code
______________________________________ ____________________________________________
Present Telephone Number, please indicate Country & City codes Permanent Telephone Number, please indicate Country & City codes
__________________________________________________________________________________________
Email Address
__________________________________________ ____________________________________________
City and Country of Birth Month/Day,/Year of Birth on Western Calendar
____________________________ ________________________ Have you taken legal steps to remain permanently?
Country of Citizenship Country of Residence, if other than Citizenship
Yes
No
__________________________ ______________________________________ _________________________
Religion (optional) Native/Home Language(s) How Many Years Have You Studied English?
Names and relationships of relatives who have attended Muskingum: _____________________________________
_____________________________________________________________________________________________
Name &Telephone Number of person we should contact if you have an emergency while on campus:
____________________________________________________________________________________________
Name Country Code City Code Telephone Number
What language(s) does this person speak? ___________________________________________________________
If you are currently in the United States, please answer the following questions:
a. Please indicate the type of visa you now hold: ___________________________________________________
b. If you are currently in F-1 status, what institution issued the Form I-20? ______________________________
Attach photo
here
Information for:
Father
Male Guardian
Spouse
_______________________________________
Family Name Given Name Middle Name
_______________________________________
Home Address, if Different from Yours
_______________________________________
_______________________________________
Employer Position/Title
_______________________________________
University Attended Degree(s)
Information for:
Mother
Female Guardian
Spouse
_______________________________________
Family Name Given Name Middle Name
_______________________________________
Home Address, if Different from Yours
_______________________________________
_______________________________________
Employer Position/Title
_______________________________________
University Attended Degree(s)
If you do not live with both parents, with whom do you make your permanent home? _____________________
Please check any that apply:
Father deceased
Mother deceased
Parents separated
Parents divorced
Parent E-Mail: _____________________________________ Does your parent speak/read English?
Yes
No
Part B. Enrollment Information
Proposed Entrance Date:
Fall/August or
Spring/January of __________
Year
Academic field(s) of study you intend to pursue: _________________________________________________
How did you become interested in Muskingum University?___________________________________________
________________________________________________________________________________________
If you are applying as a transfer student, what is your current institution, and why do you wish to change schools?
_________________________________________________________________________________________
_________________________________________________________________________________________
Please list other colleges or universities to which you are applying: __________________________________
_________________________________________________________________________________________
Part C. Educational Background
1. List every school you have attended, including primary, secondary and post-secondary institutions; use a separate
sheet of paper if necessary:
____________________________________________________________________________________________
Name of School City, Country Dates Entering & Leaving Diploma/Degree Earned
____________________________________________________________________________________________
Name of School City, Country Dates Entering & Leaving Diploma/Degree Earned
____________________________________________________________________________________________
Name of School City, Country Dates Entering & Leaving Diploma/Degree Earned
____________________________________________________________________________________________
Name of School City, Country Dates Entering & Leaving Diploma/Degree Earned
Letters of Recommendation
Please provide a letter from a teacher or headmaster who can describe your academic ability and character as a student.
Students whose primary language of instruction was not in English should also include a letter from a teacher describing
your English language ability and aptitude. Letters should be on school letterhead stationery.
Grade Reports/Transcripts
You should arrange for Muskingum to receive official or certified copies of your academic records throughout your
attendance at secondary school, college, university, and professional institutions of learning. Records should list the
individual subjects studied and the grade, mark, or other evidence that each subject was completed to the satisfaction of
the authorities in charge. Records should also include certified copies of any diplomas, degrees or other certificates
received. All records should be in English. If the language of the records is not English a certified literal translation
should be included with the original document. Since certificates and records submitted are not ordinarily returned, you
should send certified/official attested copies in addition to originals if the documents in question cannot be easily
replaced – the originals will be returned only when accompanied by certified copies. Transcripts/marksheets should be
submitted in an envelope sealed and stamped by the issuing institution. Official English translations must also be
provided when necessary. Uncertified photocopies alone are not accepted.
Test Reports
Students who are not native speakers of English should submit official results from an accepted test of English
proficiency. Contact the Director of International Admission to determine which tests are acceptable. Students from
partner institutions abroad must submit a letter from the high school affirming English proficiency at a level appropriate
for undergraduate degree study. Applicants not required submitting a TOEFL score must submit SAT or ACT results.
All test reports must be sent directly to Muskingum by the testing agency. Muskingum’s routing code is 1496 for
the SAT and 3300 for the ACT.
TOEFL_____________ ____________ __________ _________ _________ _________ _________ _________
Test Date Test Format Total Score Reading Score Writing Score Listening Score Speaking Score Grammar Score
SAT____________ _________ _________ _________ _________
Test Date Total Score Verbal Score Math Score Writing Score
ACT____________ _________ _________ _________ _________ _________ _________
Test Date Total Score Math Score Reading Score SC Reasoning Comp Score
Other Test_________________________ _____________ _________________________________________
Test Name Test Date Scores
Other Test_________________________ _____________ _________________________________________
Test Name Test Date Scores
Essay
Please include an essay of at least 500 words describing yourself and explaining why you would like to study at
Muskingum University. Also, describe any subject area you are considering and possible career plans. This essay
should be written in English.
Part D. Extracurricular Experiences and Interests
Organizations, Clubs, Activities and Teams: Attach an additional sheet, if necessary.
____________________________________________________________________________________________
Name & Description of Group/Activity Position (President, Captain, Member, etc.) Dates of Participation
____________________________________________________________________________________________
Name & Description of Group/Activity Position (President, Captain, Member, etc.) Dates of Participation
____________________________________________________________________________________________
Name & Description of Group/Activity Position (President, Captain, Member, etc.) Dates of Participation
____________________________________________________________________________________________
Name & Description of Group/Activity Position (President, Captain, Member, etc.) Dates of Participation
Employment History (if applicable): Attach an additional sheet if necessary.
____________________________________________________________________________________________
Name & Location of Type of Work Dates of Employment
____________________________________________________________________________________________
Name & Location of Type of Work Dates of Employment
Hobbies, Favorite Pastimes:
____________________________________________________________________________________________
Part E. Financing Study at Muskingum University
1. You MUST include certified bank letters and/or other evidence of financial support demonstrating your
ability to fully finance your first year’s tuition and expenses (please refer to the Prospectus for the current
tuition, fees, and related expenses).
2. Indicate the sources of your financial support and the amounts in U.S. dollars to be provided by each source for
each year that you will study at Muskingum University:
1
st
Year 2
nd
Year 3
rd
Year 4
th
year
Personal Savings
Parents
Relatives
Other Sponsors
Total
If any persons or organizations other than your parents will also provide financial support to you while you are
studying at Muskingum University, please have them provide a signed statement indicating the amount they will
provide you each year. This should also include contact information and have attached documentation of the
financial resources to be used for your education at Muskingum.
Financial Statement
_________________________________________________________________________________________
Parent/Sponsor Name(s)
_________________________________________________________________________________________
Sponsor Address Number and Street Town/City
_________________________________________________________________________________________
State/Province Country Postal Code
_________________________________________________________________________________________
Telephone Number (include country & city code) Email Address
I certify that I accept full responsibility for all of the expenses of this applicant while studying at Muskingum
University.
_________________________________________________________________________________________
Signature of Sponsor(s) Date
Part F. Applicant Signature and Date (Required)
I certify that all the information contained in this application and the supporting documents is complete and
accurate. I also understand that withholding information or giving false information may make me ineligible for
admission or may later subject me to dismissal.
_________________________________________________________________________________________
Signature Date
This application should be mailed to:
Office of International Admission
Muskingum University
163 Stormont Street
New Concord, OH 43762
USA
Muskingum University Annual Crime Statistics Disclosure
This report includes statistics for the previous three years concerning reported crimes that occurred on campus; in
certain off-campus buildings or property owned or controlled by Muskingum University; and on public property
within, or immediately adjacent to and accessible from, the campus. The report also includes institutional policies
concerning campus security, such as policies concerning alcohol and drug use, crime prevention, the reporting of
crimes, sexual assault, and other matters. You can obtain a copy of this report by contacting Campus Police or by
accessing the following website: http://www.ope.ed.gov/security/Index.aspx.
click to sign
signature
click to edit
click to sign
signature
click to edit
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome