Undergraduate International Student Application Form (PDF)

international undergraduatePrint clearly and complete both sides of this form. Missing or incorrect information will delay admission.application • application • application • application • application • application________________________________________________________________________________________________________________________________________________Name of School13. Secondary School________________________________________________________________________________________________________________________________________________Number & Street___________________________________________________________________________________________Country________________________________________________Date of Graduation (Month/Year)__________________________________________________________________________________________________ Transferring Credit: q Yes q NoName of School_____________________________________________________________ _________________________________________ __________________________________Number & Street Country Date of Graduation (Month/Year)14.Post-SecondarySchoolColleges andUniversities__________________________________________________________________________________________________ Transferring Credit: q Yes q NoName of School_____________________________________________________________ _________________________________________ __________________________________Number & Street Country Date of Graduation (Month/Year)__________________________________________________________________________________________________ Transferring Credit: q Yes q NoName of School_____________________________________________________________ _________________________________________ __________________________________Number & Street Country Date of Graduation (Month/Year)15. Test Scores_____________________ ____________________ _____________________ ____________________TOEFL Score Date Taken IELTS Score Date Taken_____________________ _____________________________ ____________________SAT/ACT Math Score SAT/ACT Critical Read/English Date Taken16.HousingOn campus apartmentsare limited. Selection isbased on students whocomplete the applicationin date order17A. I want to live on campus at Purdue Calumet’s University Village Apartments: q Yes q No17B. I want to live off campus: q Yes q NoPlease e-mail me a list of local apartments. I will find an apartment on my own. q Yes q No(E-mail addresses required on page 3.)17. SignaturePlease read carefully — sign and date: I certify that the information provided on this application isaccurate, true and complete. I understand that falsified information may result in denial of admissionand/or termination of enrollment at Purdue Calumet. I understand that all records submitted by and onbehalf of me become the property of Purdue Calumet.____________________________________________________________________________________________________Signature of Applicant_____________________________________Date of Signing (Month/Day/Year)Office of Admissions, Lawshe Hall, Rm. 130, 2200 169th Street, Hammond, IN 46323-2094 • www.calumet purdue.eduAn equal access, equal opportunity, affirmative action employer that is committed to a diverse workplace.4