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    INTERNATIONAL STUDENT APPLICATION FOR ADMISSION

    ARKANSAS TECH UNIVERSITY

    Office of International and Multicultural StudentServices

    1) Full Legal Name (as it appears on your passport)_______________________________________ ____________________________________ _______________________________

    (Family or Surname) (First Name) (Middle Name)

    2) Permanent Foreign Address__________________________________________________________ ___________________________ ___________________(Street Address or Post Office Box Number) (City) (State/Province)

    ________________ ___________________ ____________________________________ _____________________________________________________

    (Postal Code) (Country) (Telephone include country code) (E-mail Address)

    3) Mailing Address

    ________________________________________________________ __________________________ __________________(Street Address or Post Office Box Number) (City) (State/Province)

    ________________ ___________________ ____________________________________(Postal Code) (Country) (Telephone include country code)

    4) Next of Kin (Mother-Father-Spouse-Guardian)

    _____________________________________ ___________________________________ _____________________________(Family or Surname) (First Name) (Relationship to you)

    __________________________________________________________ ___________________________ ___________________(Street Address or Post Office Box Number) (City) (State/Province)

    5) Date of Birth 6) Gender* 7) Ethnic Category* (family descent)

    Month _______ Day ______ Year _______ ____ Male ____ Female ____ Not Hispanic or Latino ____ Hispanic or Latino

    *Voluntary information to be used in a nondiscriminatory manner consistent with applicable civil rights laws for reporting and statistical purposes only and cannot affect your eligibility for admission.

    8) This application is for:____ Spring (January)

    ____ Summer I (June)

    ____ Summer II (July)

    ____ Fall (August)

    of year ___________

    9) Should I be admitted, I request that my admission documents be sent:

    ____ Standard Mail (No additional charge)

    ____ Express Service via DHL, UPS, Priority Mail or FedEx (Please send an

    additional $75 (USD) check or money order for this service)

    10) Educational Objective:

    ____ English Language Institute(Intended to improve language proficiency, not interested in enrolling in college coursework at Tech)

    ____ English Language Institute, with Undergraduate Admission(Non-native English speakers without a passing TOEFL/IELTS/EIKEN score with plans to obtain an undergraduate degree)

    ____ English Language Institute, with Graduate Admission

    (Non-native English speakers without a passing TOEFL/IELTS/EIKEN score with plans to obtain a graduate degree)

    ____ Undergraduate Student

    ____ Graduate Student

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    11) Intended Major/Field of Study________________________________________________________________________

    College of Applied ScienceAgriculture Business (BPS-PS-AB)

    Animal Science (BS)

    Computer Engineering (BSEE)

    Computer Science (BS)

    Culinary Management (AAS)

    Electrical Engineering (BSEE)

    Emergency Administration and Management (BS)

    Horticulture (BS)

    Information Systems (BS)Information Technology (AAS and BS)

    Hospitality Administration, Food and Beverage Management (BS)

    Hospitality Administration, Lodging and Club Management (BS)

    Hospitality Administration, Tourism and Event Management (BS)

    Mechanical Engineering (BSME)

    Nuclear Technology (ASNT)

    Pest Management (BS)

    Recreation and Park Administration, Interpretation (BS)

    Recreation and Park Administration, Natural Resource (BS)

    Recreation and Park Administration, Turf Management (BS)

    Recreation and Park Administration, Therapeutic (BS)

    Pre-Professional ProgramsPre-Dental Pre-Pharmacy

    Pre-Dental Hygiene Pre-Physical TherapyPre-Medical Pre-Veterinary Medicine

    Pre-Law

    Masters Degree: Graduate Students

    Master of Liberal Arts (MLA)Communications

    Fine Arts

    Social Sciences

    Master of Arts (MA)English

    English with Teaching English Second Language (TESL) Option

    History

    Multi-Media Journalism

    SpanishTeaching English to Speakers of Other Languages (TESOL)

    Master of Science (MS)College Student Personnel

    Emergency Management and Homeland Security

    Engineering (MSEG)

    Fisheries and Wildlife Science

    Health Informatics

    Information Technology

    Information Technology, Computer-Based Instructional Technology

    Nursing: Administration (MSN)

    Psychology

    Bachelors Degree: Undergraduate StudentsCollege of BusinessAccounting (BSBA)

    Business Education (BS)

    Economics and Finance (BSBA)

    Management and Marketing (BSBA)

    College of EducationEarly Childhood Education (AS and BS)

    Middle Level Education English LanguageArts/Social Sciences (BS)

    Middle Level Education Math/Science (BS)

    Health and Physical Education Teacher Licensure (BS)

    Health and Physical Education Wellness Fitness (BS)

    College of Arts and HumanitiesArt Education (BA)

    Art, Fine Art (BA)

    Art, Graphic Design (BA)

    Creative Writing (BFA)

    Creative Writing Education (BFA)

    Criminal Justice (AA)

    English (BA)

    English Education (BA)

    Foreign Languages (French, German, Spanish) (BA)Foreign Languages Education (French, German, Spanish) (BA)

    History (BA)

    International Studies (BA)

    Journalism, Broadcast (BA)

    Journalism, Public Relations (BA)

    Journalism, Print (BA)

    Music (BA)

    Music Education Instrumental (BME)

    Music Education Keyboard Instrumental (BME)

    Music Education Keyboard Vocal (BME)

    Music Education Vocal (BME)

    Political Science (BA)

    Psychology (BA)

    Rehabilitation Science (BA)

    Social Studies Education (BA)Sociology (BA)

    Spanish Medical Interpretation (BA)

    Speech, Communications (BA)

    Speech, Theatre (BA)

    Speech Education (BA)

    College of Natural and Health SciencesBiology (BS)

    Biochemistry (BS)

    Chemistry (BS)

    Chemistry Professional (BS)

    Engineering Physics (BS)

    Environmental Biology (BS)

    Environmental Chemistry (BS)

    Environmental Geology (BS)Fisheries and Wildlife Biology (BS)

    Geology Professional (BS)

    Health Information Management (BS)

    Mathematics (BS)

    Mathematics Education (BS)

    Medical Assistant (AAS)

    Medical Technology (BS)

    Nursing (BSN)

    Physical Science (BS)

    Physical Science, Nuclear Physics Option (BS)

    Physical Science, Physics Option (BS)

    Physical and Earth Science Education (BS-PSED)

    Life and Earth Science Education (BS-LSED)

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    13) Citizenship Information (If you have Permanent Residency in the US Green Card stop and go to last page for more instructions.)

    Country of Citizenship____________________________ City and Country of Birth_________________________, ____________________________

    Passport Number _________________________ Expiration Date____________________ Country Issuing Passport___________________________

    14) Is English your native language? Yes ____ No ____ If no, what is your native language? ______________________________________

    15) Will any dependents accompany you?Yes ____ No ____ If Yes, then please list their information below and include a copy of theirpassports:

    ___________________________________________________________________________________________________________________________________

    Family (Surname) Given Name Date of birth Country of Birth Relationship to you

    _________________________________________________________________________________________________________

    16) Current Educational ExperienceAre you currently attending a college/ university? Yes ___ No ___

    If yes, is this school in the USA? Yes ___ No ___ (If yes, please enclose a copy of your I-20 or Form DS-2019 and visa)

    List the courses in progress: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

    Will you be receiving a degree? Yes ____ No ____ Type of degree ______________________________________________________________

    If you currently attend another college/university state reason for discontinuing: ____________________________________________________

    __________________________________________________________________________________________________________________________________

    17)Have You Ever Applied/Enrolled at Arkansas Tech University? Yes _____ No _____ If yes, indicate year _________________

    18) Previous Education

    List in chronological order all the high school/upper secondary and post-secondary schools you have attended.

    Name of Secondary School and/or

    University Attended

    Location

    (City/Country)

    Dates Attended

    (mm/yy - mm/yy)

    # Years

    Attended

    Type of diploma, certificate or degree

    received, if any

    12) TEST REPORTSPlease arrange for an official report to be sent from the appropriate testing agency. The institutional code for the TOEFL, SAT and GRE is

    6010 and for the ACT is 0114. TOEFL/IELTS/EIKEN scores are not required for ELI applicants.

    Minimum scores for undergraduate and graduate admission are listed below. Scores must be less than 2 years old.

    Undergraduate Students Graduate Students

    TOEFL 173 (computer) 500 (written) 61 (Internet) TOEFL 213 (computer) 550 (written) 79 (Internet)

    IELTS 5.5 or higher IELTS 6.5 or higher

    EIKEN 2A or higher EIKEN Pre-1or higher

    TOEFL/IELTS/EIKEN SAT ACT GRETest Date Score Test Date Score Test Date Score Test Date Score

    Month/Year Month/Year Month/Year Month/Year

    Arabic

    High School

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    PLEASE READ THE FOLLOWING INFORMATION BEFORE SENDING APPLICATION FORM

    Submission DatesPriority consideration will be given to those applications received by May 1 for the fall semester, October 1 for the spring semester, and March 1 for both summer terms. Applicationsare accepted after these dates.

    Immunization RequirementsPersons born after January 1, 1957 must furnish proof of immunity against measles, mumps, and rubella (MMR) to the ATU Health and Wellness Center prior to enrollment in classesThis includes two immunizations for MMR. All international students are required to have a TB skin test after their arrival to campus. Only tests completed in the U.S. are accepted.Placement TestFirst-time entering undergraduate degree-seeking students must furnish official ACT or SAT scores to the International and Multicultural Student Services Office prior to enrollment iclasses. If ACT or SAT scores are not available prior to enrollment, the student must take the COMPASS exam to determine appropriate English and mathematics course level placemenupon arrival.Permanent Residency (Green Card)If you have U.S. Residency (green card), you will not apply for admission through the Office of International and Multicultural Student Services. Undergraduates need to contact the Officof Admissions, Doc Bryan Student Services Building Suite 141, Russellville, AR 72801, or visit their web site at http://admissions.atu.edu/ for an application packet, or by phone at (479968-0343. Graduates please contact the Graduate College, Tomlinson 113, Russellville, AR 72801, or visit their web site at http://graduate.atu.edu for an application packet, or by phoneat (479) 968-0398.

    Arkansas Tech University does not discriminate on the basis of color, sex, race, age, national origin, religion, or disability in any of its practices, policies, or procedures. This includes, buis not limited to, admission, employment, financial aid or educational services. Arkansas Tech University complies with all applicable state and federal laws including, but not limited toTitle VI and Title VII of the Civil Rights Act of 1964 as amended, Title IX of the Educational Amendments of 1972, Section 504 of the Rehabilitation Act Amendment of 1974, the CivRights Restoration Act of 1987, the American With Disabilities Act of 1990, and the Civil Rights Act of 1991. The Affirmative Action Office, Administration Building, Suite 200, has beendesignated to coordinate compliance efforts.

    To maintain a safe learning community, we ask the following of all applicants. We cannot process your application unless you answer

    these questions. Answering yes to one or more of the following questions will not necessarily preclude you from being admitted.

    However, failure to provide complete, accurate, and truthful information will be grounds to deny or withdraw admission, or to dismiss

    after enrollment.

    19) Have you ever been convicted of, or pleaded no contest to, a crime other than a minor traffic violation?

    Yes ____ No ____

    20) Do you have any criminal charges pending against you? Yes ____ No ____

    21) Have you ever been expelled, dismissed, suspended, or placed on probation by any other school, college

    or university? Yes ____ No ____

    22) If you have ever served in the military, did you receive any type of discharge other than an honorabledischarge? Yes____ No ____

    You must promptly notify the IMSSO of any criminal charge, any disposition of a criminal charge, or any school, college, or university disciplinary action

    against you, or any type of military discharge other than an honorable discharge that occurs at any time after you submit this document. If you do not

    understand the meaning of a question, please contact the IMSSO for further clarification before answering.

    Please return completed application to:

    International & Multicultural Student Services

    Arkansas Tech University

    1507 North Boulder Ave, Tomlinson Room 29

    Russellville AR 72801 USA

    If you have questions, please contact us:

    Telephone Number: (479) 964-0832

    Fax Number: (479) 880-2039

    E-mail: [email protected]

    Website: http://www.atu.edu/imsso

    23) Application Fee Payment InformationA non-refundable application fee of $50 is required from each international applicant. Graduate applicants must include an

    additional graduate application fee of $25. If you would like your I-20 sent by express courier, please add an additional $75 for this

    service. Please fill out the form below to pay by credit card, or send a check or money order.

    ____International Student Application Fee $50 ____Express Courier Service Fee $75

    ____Graduate School Application Fee $25 TOTAL $___________

    Credit Card Type: ____Discover ____Master Card ____VISA

    Credit Card Number:______________________________________________________________________________________________

    Expiration Date (Month/Year):________________________________ Security (CVV/CVC) Code:___________________________

    24) AgreementBy signing below, I hereby affirm that all information supplied in this application is complete and accurate. It is my understanding

    that I shall not be considered for admission to Arkansas Tech University until I have submitted all credentials specified (including

    application fee(s), official academic records, affidavit of financial support, official language proficiency results, required test scores

    and a copy of my passport. I understand that withholding information requested or giving false information may make me ineligible

    for admission and enrollment.

    __________________________________________________________________________ ____________________________Applicants Signature Date (Month/Day/Year)

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    2012-2013 International Admission Undergraduate Check List

    Undergraduate Students

    Official application for international admission

    $50 application fee payable in US fundsAccepted Methods of Payment

    1. Cash (USD Only)2. Credit Card (Visa, MasterCard or Discover) please include the following information:

    Credit card number, expiration date, V-Code (3-digit number on the back of the credit card)3. Money Orders, Cashier Checks or Personal Checks: Please make payable to ATU International and Multicultural Student Services OfficeATTENTION! All money orders, cashier checks or personal checks must follow these guidelines or they will not be accepted:

    1. Drawn on a US Bank with the banks 9 digit routing number in the lower left corner2. Denote USD or US Dollars3. All but personal checks, must be imprinted, NOT handwritten

    TranscriptsSubmit secondary academic records and a copy of your diploma or leaving certificate. All academic records MUST be originals or certified copies oforiginals with official English translations. Certified true copies must be certified (both signed and with a seal/stamp affixed) by a registrar, headmaster,or other official at the school where the grades were obtained. Notarized copies will NOT be accepted, because notary publics do not verify theauthenticity of the document.

    Passing TOEFL/IELTS/EIKEN ScoreStudents who wish to apply for admission to the English Language Institute (ELI) are not required to demonstrate English proficiency. All otherapplicants should meet one of the following criteria. A minimum score of 500 on the written TOEFL (Test of English as a Foreign Language), 173 on thecomputerized TOEFL or 61 on the Internet-based TOEFL. Scores must be received directly from Educational Testing Service (ETS). The school codefor Arkansas Tech University is 6010. IELTS (International English Language Testing System) scores are also accepted. A minimum IELTS score of 5.5or higher must be provided for admission. An EIKEN score of Grade 2A. Scores must be sent directly from STEP, Inc. (Society for Testing EnglishProficiency). Students may also take any similar test of English proficiency approved by Arkansas Tech University at a site authorized by ArkansasTech University. Test scores cannot be more than two years old.

    Bank Statement of Financial SupportApproximately $20,474 (USD) is needed for one academic year (nine months) of undergraduate study. Certified evidence of the source (specific nameof sponsor and relation to student) and amount of financial support must accompany the application. A current financial statement must come directlyfrom the sponsor's financial institution. All bank documentation must be original and cannot be more than six months old. No photocopies are accepted.

    Copy of Valid PassportTransfer Students

    Above requirements must be submitted along with the following:

    Transfer Applicants with fewer than 24 credit hours must also provide official secondary school academic records. Normally, a maximum of 68 semesterhours of acceptable credit may be transferred from community or junior colleges. For full acceptance, transfer credit must average a 2.00 (on a 4.00 scale)or better. Transfer credit is awarded on a course-by-course basis, and final evaluation of transfer credit may not be completed until after the student's arrivaon campus. Transfer students are required to submit transcripts to an approved credential evaluation service for a course-by-course evaluation along withwritten course descriptions in English. Credential evaluation services approved by Arkansas Tech University include:

    Educational Credential Evaluators, Inc. (www.ece.org)Global Credential Evaluators, Inc. (www.gcevaluators.com)Global Education Group, Inc. (www.globaledu.com)

    World Education Services (www.wes.org)

    English Proficiency:Completion of English Composition I and English Composition II from a US College/University with a grade of C or better will be accepted as proof ofEnglish proficiency in place of the TOEFL/IELTS/EIKEN.

    Copy of your I-94 card Copy of your I-20 or DS-2019 Copy of your visa

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    2012-2013 International Admission Graduate Check List

    Graduate Students

    Official application for international students

    $50 application fee payable in US fundsAccepted Methods of Payment

    1. Cash (USD Only)2. Credit Card (Visa, MasterCard or Discover) please include the following information:

    Credit card number, expiration date, V-Code (3-digit number on the back of the credit card)3. Money Orders, Cashier Checks or Personal Checks: Please make payable to ATU International and Multicultural Student ServicesATTENTION! All money orders, cashier checks or personal checks must follow these guidelines or they will not be accepted:

    1. Drawn on a US Bank with the banks 9 digit routing number in the lower left corner2. Denote USD or US Dollars3. All but personal checks, must be imprinted, NOT handwritten

    $25 Graduate School fee payable in US fundsSame payment details as listed above. Please make money orders, cashier checks or personal checks payable to ATU GraduateCollege.

    TranscriptsSubmit ALL college, and university academic records. Only four year bachelors degrees are honored: three year bachelor degrees are not honored for

    admission into the Graduate School. All academic records MUST be originals or certified copies of originals with official English translations. Certifiedtrue copies must be certified (both signed and with a seal/stamp affixed) by a registrar, headmaster, or other official at the school where the gradeswere obtained. Notarized copies will NOT be accepted, because notary publics do not verify the authenticity of the document.

    Passing TOEFL/IELTS/EIKEN ScoreStudents who wish to apply for admission to the English Language Institute (ELI) are not required to demonstrate English proficiency. All otherapplicants should meet one of the following criteria. A minimum score of 550 on the written TOEFL (Test of English as a Foreign Language), 213 on thecomputerized TOEFL or 79 on the Internet-based TOEFL. Scores must be received directly from Educational Testing Service (ETS). The school codefor Arkansas Tech University is 6010. IELTS (International English Language Testing System) scores are also accepted. A minimum IELTS score of 6.5or higher must be provided for admission. An EIKEN score of Grade Pre-1. Scores must be sent directly from STEP, Inc. (Society for Testing EnglishProficiency). Test scores cannot be more than two years old.

    Bank Statement of Financial SupportApproximately $16,808 (USD) is needed for one academic year (nine months) of graduate study. Certified evidence of the source (specific name of

    sponsors and relation to student) and amount of financial support must accompany the application. A current financial statement must come directlyfrom the sponsor's financial institution. All bank documentation must be original and cannot be more than six months old. No photocopies are accepted.

    Copy of Valid Passport

    Transfer StudentsAbove requirements must be submitted along with the following:

    Final transcript with grades posted from your current college/university Copy of your I-94 card Copy of your I-20 or DS-2019

    Copy of your visa