,
California State Universitv, Fresno
International Admissions, 211 Joyal Administration .B'ullding, MIS JA 56
California State University, Fresno, Fresno, California 93740-8026 U.S.A.
(559) 278-2409
Fax•
(559) 278-7011
•Electronic
Mail: intladm@listserv.csufresno.edu
INTERNATIONAL APPLICATION
Please type or
print
clearly. Please complete
all
sections.
US
Social Security
Number
(if
none, leave blank):
DOD-DD-DODD
For Office
Use
Only
Semester applying for (please
,/
check one term only) :
D
Fal
l or D Spring
Year
Receipt
No.
Name
(as on passport):
Full legal family/lase
name
First/given name Middle
name
Dare
Birthdace (month/day/year):
DD-
DD-
DD
Gender (circle one): Male Female
Country
of
Birth: City
of
Birth:
Fee
Status
By
Country
of
Citizenship:
PS
ID
Country
of
Nationality:
Residence Scams
F
If currently residing in California, list county
of
Residence:
Ethnic
Code
Current Mailing Address:
Permanent Street Address (in your country):
Admit
Type
(if
US,
no
P.O.
BOX)
(required)
Res. Area
Code
AJ)(Mru/
A
JNMill
I
Notes:
Af>OM><J A
/NMillJ
OTY
STATE OOUNTRY
GTY
jT
A
TE
COU
.Y
71W
f'05TAl
CODE
r<JS
TAL
CODE
Phone: Phone:
This address
is
valid until
Fax:
ruTE
Internet (E-mail) Address
Entered by Dace
Major:
Mark box with degree objective:
Option
(if
applicable):
D
(O)
Exchange student/special program
Mark box with current student level:
(2) Bachelor
of
Arts
(3) Bachelor
of
Science
D
(O)
No
units completed
(5) Master
of
Arts
(1)
Less
than
30
units transferring
( 6) Master
of
Science
(2)
30
-59.5 units transferring
(7)
Other
Masters
(MBA,
MPH,
MFA,
MPT,
MSW.
MPA)
(3)
60-89.5 units transferring
(8)
ED.D
.
(4)
90+ units transferring
(9)
Other
(5) Bachelor's/Master's degree earned
Have you ever applied to California
State University, Fresno before? OYes 0 No
Have you ever attended California
State University, Fresno before? 0
Yes
0
No
If
Yes,
ID#
used and Name
If
Yes
, please write the last semester/term you attend
Year
Have you taken the TOEFL?
Do
you plan to attend
an
English language school?
0
Yes
Date:
OYes
Dace:
0
No
If
no, do you wish
co
know
if
you meet admission crice-
DNo
ria before you attend language school D
Yes
D
No
If
yes, please list name and location
of
the program:
Have you taken the GRE/GMAT/MAT?
0
Yes
Dace:
0
No
When
will you take
it?
What
is
your native language?
A non-refundable Application Fee of $55 USD must accompany this application
Concurrent Enrollment
Will you be attending another university or college while attending California State University, Fresno for the term
this application
is
for ?
Yes
0
No
0
If
"Yes",
which university or college will you
be
attending?
Do you
possess
a valid 1-20 or DS-2019 from that university or college?
Yes
0
No
0
Will you be enrolled
at
that university
or
college
on
a full-time
basis?
Yes
0
No
0
Will you be enrolled
at
California State University, Fresno for
at
least 12 units?
Yes
0
No
0
Visa Information
Do you now hold a valid US
visa?
Yes
0
No
0 IfYes, type
(Fl,
JI,
E2,
etc.):-------------
If
you hold
an
F-1 visa, list issuing school's name and your 1-94 Admission number:
__________
_
Date
Visa issued: Visa Issuing
City:------------------
If
you hold a J-1 visa,
give
name/address
of
Responsible Officer:
------------------
If
Family members will be coming to the USA with you, please complete the information below:
Name (Family/last, First/given)
Birthdate
City
&
Country
of
Birth Relationship
Educational History
Please complete accurately
and
completely the instructions for each numbered column below. Begin with kindergarten/preprimary school.
1.
Write the beginning
and
ending date you attended an educational institution.
2. Write the full name
of
the school.
3.
Write the type
of
school you attended, such
as
Volkschule, gymnasium, Lycee, Colegio, Ecole Superior, Teacher's college, Junior
College,
Universiry,
ecc.
4.
Write
the
location
of
the school (ciry, state, province, region, country).
5.
Write the name
of
the certificate
or
degree earned
or
chat will be earned
at
a future dace
(high School diploma,
0
or
A levels, S.S.C., H.S.C., A.A., B.A., Ph.D., or other degrees).
1
2
3 4
5
Dace Enrolled
Name
of
Location
of
School
Certificate/ Degree
Month/Year
Month/Year
Full Name
of
School
Type
of
School
(City,
Stace, & Country)
&
Date
Earned
I
I
Courses in Progress or Planned
Please list the courses that you are enrolled
in
or
will enroll
in
before attending California State University, Fresno
(do
not
list
if
courses already appear
on
transcripts).
Course
Hours/ Completion
Abbreviation
Course Title
Uni
cs
Date
Name
of
School
* Remember to sign the applicaton
on
the next page.*
Ethnic identity/ origin
Enter appropriate code in box (optional). D
1 - American Indian
or
Alaskan native;
tribe
------------------
2 - Black, non-Hispnaic, including African-American
3
- Mexican-American, Mexican, Chicano
A
- Central American
B
- South American
Q-
Cuban
P - Puerto Rican
4 -
Other
C - Chinese
J
- Japanese
K
- Korean
5
-
Other
Asian
M
- Cambodian
L - Laotian
V - Vietnamese
T
-
Thai
S -
Other
Southeast Asian
G
- Guamanian
H
- Hawaiian
N - Samoan
7
- White
8 -
Other
______________
_
9
-
No
Response
D
- Decline to State
If
you have a physical, perceptual, psychological
or
learning disability, enter a
Yin
the box (optional). D
Do
you have the interest
and
ability to participate
in
NCAA-sanctioned intercollegiate athletics competition
(optional)?
Yes
0
No
0
If
yes, you should contact the campus
Department
of
Athletics to register your interest
in
a sport
or sports.
Is
either parent a
CSU
graduate (optional)?
Yes
0
No
0
If
yes,
which campus?
____________
_
What
are your parent's highest level
of
formal education
(optional)?
Enter code
in
box for Mother D
and
Father D
I
-
No
High
School
2
-
Some High School
3 -
High School Graduate
4
-
Some College
5
-
2-Year College Graduate
6
-
4-Year College Graduate
7 -
Postgraduate
Certification-to be read and signed
by
all
applicants
to
certify the accuracy
of
the
information provided.
I certify under penalty
of
perjury,
or
after first being duly sworn, that I have provided complete
and
accurate re-
sponses
to
the items
on
this application. I further certify (swear) all official documents submitted
in
support
of
this
application are authentic and unaltered records that pertain to me. I authorize release
of
any
information submitted
by me in connection with
my
application
to
any person, firm, corporation, association
or
government agency,
but
only
to
verify or explain the information, obtain pertinent records, or in connection with perjury proceedings.
My
signature certifies the accuracy
and
completeness
of
the information provided. I understand that
any
misrepresenta-
tion may be cause for denial
of
cancellation
of
admission or enrollment.
I certify (swear) that so long
as
I
am
a student
at
this institution, I will advise the residence clerk
if
there is a change
in any
of
the facts affecting
my
residence.
I agree
to
meet the California State University comprehensive health insurance requirement for the duration
of
studies/practical training
as
listed
on
my 1-20 or DS-2019 form.
Signed at
City
and
County
Applicant's Signature Date
Nondiscrimination
Policy--
The
California State University does
not
discriminate
on
the basis
of
race, color, na-
tional origin, sex, physical handicap
or
sexual orientation in the educational programs
or
activities
it
conducts.