Name: Social Security Number:

Permanent Address Ouside USA

Address:

City:

ZIP/Postal Code:

Country:

Phone:

Mobile Phone:

Current mailing address in USA if available:

Address:

City:

ZIP/Postal Code:

Phone:

Mobile Phone:

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E-Mail Address: Date of Birth: Sex:

Male Female

Ethnic Origin:

American Indian Asian/Pacific Islander White (Non-Hispanic) African Hispanic Other

Citizenship:

U.S. Citizen U.S. Permanent Resident Non-U.S. Citizen

Country of Citizenship: City of Birth: Alien Registration Number: Current Visa/Status held: I-94 number: I-94 expiration date:

When do you plan to begin classes?

Fall Quarter (September) Winter Quarter (January) Spring Quarter (April) Summer (July)

You are now applying as:

Freshman Transfer Student For Second Degree

TOEFL Score: TOEFL Date: Major area of interest:

Accounting Management Criminal Justice International Business Computer Science Office Administration Liberal Arts Marketing General Business Physical and Biological Sciences Social and Behavioral Sciences English as a Second Language English and Communications Mathematics Electronics Engineering Technology ENDT (Electroneurodiagnostic Technology) 9-Month Certificate: Medical Office Technology 9-Month Certificate: General Office Assistant 9-Month Certificate: The New Digital Media Designy 9-Month Certificate: E-Commerce

Degree Type:

2-Year Associate's Degree 4-Year Bachelor's Degree 9-Month Certificate International Business

High School Diploma

Name of High School:

City:

Country:

Graduation Year:

Post-secondary schools attended

Institution Name	City	State/Country	Dates Attended		Degree Hours Earned
			From	To

East-West University complies with the Family Educational Rights and Privacy Act of 1974 (Buckley Amendment). Federal Regulations require the collection of statistical information concerning ethnic origin, age and sex of our applicants. East-West University admits student without regard to age, race, color, sex, religion, physical handicap and national or ethnic origin).

PLEASE NOTE: Applicant born after January 1, 1957 are required by law to submit medical records showing immunization from certain communicable diseases; diphtheria , tetanus, measles, rubella, and mumps.

I understand that withholding information requested or giving false information may render me ineligible for admission to East-West University or subject to dismissal. I certify that the information provided on this application is correct and complete.

By checking the field below, I certify that I read all of the above and agree this application to be submitted for review to East-West University.