International Admission Application

ABOUT SSL CERTIFICATES

Admission Status

Intended Major:

If other or undeclared, please specify

Personal Information

Given Name: Middle Name:

Surname:

Permanent Mailing Address:

City: Country:

Province/State: Postal Code:

Telephone: ( ) -
Fax #: ( ) -

E-mail:

Address of Present Residence (To send I-20 and other correspondence):

Telephone: ( ) -
Fax#: ( ) -

Citizenship: If other specify:

If other, are you a permanent resident of the US?

Birthdate (month/day/year): / /

Gender:

Do you have a Social Security Number?

If yes, please provide Social Security Number: - -

*Optional

Church Name:

Street Address:

City:
Country: Postal code:

Denomination:

Pastor's Full Name:

Phone Number: ( ) -

Educational Background

Please list all secondary schools you have attended. List most recent school first. Indicate any certificates or exams you have taken or will be taking.

Secondary Education	Address	Country	From	To

Please list all universities at which you have taken courses for credit (whether or not credit was received). Please note that concealment of previous work will cancel and nullify the processing of your application and is grounds for dismissal from Geneva.

College/University	Address	Country	From	To

Please list your native language:

Years of formal study of English language:

TOEFL Scores (give dates of each examination):

Honors and Activities
List any scholastic distinctions or honors you have received in secondary school. Also include any activities/athletics you have participated in and any leadership positions you have held.

Anticipated activities at Geneva:

List other schools you are applying to:

Family Information

Name of Parents/Guardians:

Father's Occupation:

Mother's Occupation:

Parent's Address (if different from above):

Are you married? Number of Children:

Name of Spouse (if married):

Maiden Name (if applicable):

Please list the dependents who will come to the US with you:

Name	Birthdate date	Gender	Country of Birth	Relationship to you

Health

The following information will help us assist you while at Geneva. You will not be discriminated against in the admissions process because of this information.

1. Have you ever been diagnosed as having a learning disability?

2. Do you have any health conditions or physical disabilities that require special attention?

Please note:You will be billed for health and accident insurance when you arrive, unless you submit proof of insurance when you arrive. The cost to you will be approximately $804 per year.

How did you first learn of Geneva? (Please select the one which best describes how you first heard of Geneva College)

IES Guide to American Schools, Colleges and Universities
Career Formation, Inc.
International Education Services
Education International
College Fair
Counselor visit to your school
Study in USA Magazine
Geneva's Web site
Other:

Short Answer Essay Questions:
In 3-5 sentences, please thoughtfully answer the questions below.
(Note: Your answers to these questions may be used in the scholarship selection process.)

1. Why are you interested in pursuing a Christian education at Geneva College?

2. What are your goals and how do you see Geneva College helping you achieve them?

3. What distinguishes you for consideration among your peers as a student at Geneva College?

I certify that the information in all of my credentials is complete and accurate to the best of my knowledge and I understand that the falsification of information may be grounds for immediate dismissal from my studies. I agree to comply with any necessary regulations while enrolled at Geneva College.

Please sign this form by typing your name and typing the date in the spaces provided below. Your signature validates this application and indicates that you have completed the information and that the information is true.

Signature* Date*