UNIVERSITY OF CALIFORNIA, IRVINE, DIVISION OF CONTINUING EDUCATION

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1 UNIVERSITY OF CALIFORNIA, IRVINE, DIVISION OF CONTINUING EDUCATION BERKELEY DAVIS IRVINE LOS ANGELES MERCED RIVERSIDE SAN DIEGO SAN FRANCISCO SANTA BARBARA SANTA CRUZ University Programs, International Programs Telephone: Fax: Website: ce.uci.edu/international/universityprograms Enrollment Application for International Graduate Studies Preparation Program (IGSPP) 1 PERSONAL INFORMATION (All information must be truthful and accurate regarding the applicant; otherwise the application will not be processed.) Please type or clearly print your name exactly as it appears on your passport. (Include a recent passport copy.) Last Name (Family name) First Name (Given name) Male Female Date of Birth / / Month Day Year Country of Birth Country of Citizenship Name of College/University Date of College/University Graduation College/University Grade Point Average (GPA) Highest TOEFL/IELTS Score (dated within two years of this application) Any Other Standardized Test Scores (GMAT, GRE, etc.) TRANSCRIPT - Enclose official copies of all your transcripts after high school. STUDENT S PERMANENT ADDRESS IN HOME COUNTRY Street Address City Postal Code Country Permanent Telephone (required) 2 SELECTION OF PROGRAM Check the appropriate boxes to indicate your preference for program track and attendance dates. Starting Year Starting Quarter Fall Winter Spring Summer 3 HOUSING Access Track Major ACP Program Track Business Administration Data Science & Predictive Analytics (FA, WI, & SP) Global Human Resources Mgmt (FA & SP) Int l Business Law (WI & SU) Int l Business Operations & Management Int l Finance (FA & SP) Int l Tourism & Hotel Management (WI & SU) Marketing Media & Global Communications (WI & SU) Project Management Students generally must stay in University Apartments during the first quarter of IGSPP. There is a non-refundable $150 placement fee and a non-refundable $300 reservation fee. Summer applicants: University Apartments includes Welcome Week Homestay during the First Week of the Program. Please check with the University Programs Office regarding Welcome Week Homestay. Failure to do so may result in no housing placement or higher housing fees. CHECK ( ) this box if your permanent address is the same as your mailing address. Please check ( ) your preference below: One quarter Two quarters Three quarters STUDENT S CONTACT INFORMATION FOR ALL IMPORTANT CORRESPONDENCE Name Street Address City Postal Code Country Permanent Telephone (required) WeChat ID (required for applicants from China) Private Bedroom and Private Bath in a Shared Apartment Shared Bedroom and Shared Bath in a Shared Apartment Roommate Request (of the same gender) (Name and/or Country) The request must be received by the IGSPP office at least 30 days prior to the Program Start Date. Final approval depends on apartment availability and placement. Agent s $6,500 USD $3,250 USD I do not wish to stay in University Apartments and will submit a completed Housing Waiver to receive approval for exemption. $12,000 USD $6,000 USD $18,000 USD $9,000 USD Rev 09/16

2 5 VISA INFORMATION All full-time programs require an F-1 student visa. An I-20 is required to obtain an F-1 student visa. Do you need an I-20? Yes, I need an I-20 for (check one) an F-1 visa change of visa status school transfer (Please complete the section below.) If you are changing your visa status to F-1 within the U.S. or transferring from a different U.S. school, please provide your current local address: Street Address (Must not be a P.O. Box) City State Postal Code Complete this section only if you are transferring from another U.S. school. Will you be leaving the U.S.A. before starting our program? Yes, I will leave on / / Month Day Year No, I do not need an I-20. I am (check one): U.S. Citizen/Permanent Resident Other non-immigration status: 5 DEPENDENT INFORMATION No Name of your current school Your SEVIS ID number Please include copies of your: Current I-20 F-1 visa page Passport information page CBP admission stamp in your passport OR I-94 number retrieval record ( OR front and back of your paper I-94, if you have one. Do you intend to bring your spouse and/or children with you? No Yes, I will bring my (check all that apply): Spouse Children: How many children? Please include passport copies and an additional $2,000 USD per dependent on the bank statement. 6 FINANCIAL INFORMATION (I-20 Applicants Only) Submit a bank-certified financial statement on official bank letterhead to prove that you have sufficient funds to cover tuition and living expenses during the period of study in the program. All funds must be stated in U.S. dollars, and the statement must be dated within six months of the date when the application is received and be for liquid assets, e.g., funds which are immediately available. STATEMENT OF FINANCIAL SUPPORT The person who is financially responsible for you must read and sign the statement below. If you are financially responsible for yourself, you may sign the statement yourself. Name of Person/Organization Financially Responsible Relationship to Student Signature Date 7 REPRESENTATIVE INFORMATION Please complete this section if the applicant is referred by a representative. Educational Agency Embassy School/Partner Institution Other (e.g., parent, spouse, friend, etc.) Contact Name Contact IMPORTANT Sign below to authorize UCI DCE to release your financial and academic records, I-20, and any documents pertaining to your immigration status to the agent/representative listed above. See for more information about student record privacy. Student s Signature 8 PAYMENT PROCEDURE To apply, include the following required non-refundable fees: $200 Enrollment Application Fee $50 International Programs Online Placement Test Registration Fee (for students without qualifying TOEFL/IELTS scores) Please make your payment with one of the following options: 1. Phone: (available Monday through Friday 8am-5pm PST) OR 2. Complete the Credit Card Authorization Form and submit by: 9 HEALTH INSURANCE Students must have health and liability insurance that meets program minimum requirements. UC health insurance is included in the program fee for IGSPP. I understand and agree to the above. Student s Signature Fax: OR Mail: UC Irvine Division of Continuing Education IGSPP Office P.O. Box 6050 Irvine, CA U.S.A. Note: According to Payment Card Industry Data Security Standard (PCI DSS) requirements as set forth by the PCI Security Standards Council, sending credit card information by is not allowed and not secure. For more information about PCI DSS requirements, please visit 10 STUDENT SIGNATURE (required) STUDENT SIGNATURE I certify that the information on this entire form is correct to the best of my knowledge. I agree to pay the required and non-refundable application fee. I acknowledge that UC Irvine (including DCE) is a non-smoking campus, and that failure to comply with the non-smoking policy may subject me to administrative action. Student s Signature Date

3 PLEASE ANSWER THE QUESTIONS BELOW AS FULLY AND AS LEGIBLY AS YOU CAN. USE YOUR OWN WORDS. YOU MAY PRINT AND ATTACH ADDITIONAL SHEETS IF YOU WISH. 1. Describe your education up to now. Include any college experience, degree(s), and major(s). 3. Describe why you are interested in the specific track (program) you have chosen to study in IGSPP. 2. Describe your work experience. Include any volunteer jobs and/or paid jobs you have had. 4. Describe your future goals or career plans and how IGSPP will help you achieve these plans.

4 U N I V E R S IT Y O F C A L I F O R N I A I R V IN E D IV I S I O N O F C O N T IN U I N G E D U C A T I O N U n iv e r s ity P r o g r a m s IG S P P H o u s in g W a iv e r R e q u e s t P le a s e c o m p le te th e I G S P P H o u s in g W a iv e r R e q u e s t F o r m a n d s u b m it it to I G S P u c i.e d u w ith th e c o m p le te d I G S P P a p p lic a tio n. I a m re q u e s tin g to w a iv e th e firs t q u a rte r h o u s in g re q u ire m e n t fo r th e In te rn a tio n a l G ra d u a te S tu d ie s P re p a ra tio n P ro g ra m (IG S P P ). T h e fo llo w in g c irc u m s ta n c e s a re in s u p p o rt o f m y re q u e s t. I u n d e rs ta n d th a t I a m re s p o n s ib le fo r s e c u rin g m y o w n h o u s in g fo r m y firs t q u a rte r d u rin g m y In te rn a tio n a l G ra d u a te S tu d ie s P re p a ra tio n P ro g ra m. In a d d itio n, I u n d e rs ta n d th a t I a m re s p o n s ib le fo r m e e tin g th e a c a d e m ic re q u ire m e n ts o f IG S P P, a n d a n y d iffic u lty th a t m a y a ris e d u e to m y in d e p e n d e n t h o u s in g c h o ic e s c a n n o t b e u s e d to ju s tify p o o r a c a d e m ic p e rfo rm a n c e. I u n d e rs ta n d th a t it is m y re s p o n s ib ili ty to a tte n d o rie n ta tio n a n d s e a rc h in g fo r h o u s in g c a n n o t b e u s e d to ju s tify m is s in g o r ie n ta tio n o r a n y o th e r a b s e n c e s. I a ls o u n d e rs ta n d th a t if a h o u s in g w a iv e r is re q u e s te d, I w ill lo s e m y p o s itio n o n th e h o u s in g p re fe re n c e lis t a n d th e re is n o g u a ra n t e e th a t h o u s in g w ill b e a v a ila b le to m e la te r. I u n d e rs ta n d th a t U C I D C E s o ffic e c a n re fe r h o u s in g o p tio n s, b u t my s e a rc h fo r h o u s in g is in d e p e n d e n t a n d m y re s p o n s ib ility a lo n e. I a m re s p o n s ib le fo r a n y c o n s e q u e n c e s th a t m a y re s u lt fro m m y in d e p e n d e n t h o u s in g c h o ic e s. I M P O R T A N T : T h e w a iv e r r e q u e s t m u s t b e r e c e iv e d b y o u r O ffic e n o la te r th a n th e P r o g r a m D e p o s it is m a d e in o r d e r to b e c o n s id e r e d. T h e O ffic e m a y a s k s tu d e n ts to p r o v id e a d d itio n a l p r o o f o r e x p la n a tio n s if n e c e s s a r y. I f th e h o u s in g p la c e m e n t is a lr e a d y d o n e b e fo r e th e O ffic e a p p r o v e s th e w a iv e r a n d th e fo r m is r e c e iv e d a t le a s t 3 0 d a y s b e fo r e th e p r o g r a m s ta r t d a te, s tu d e n ts w ill s till b e r e s p o n s ib le fo r p a y in g th e p la c e m e n t a n d r e s e r v a tio n fe e s o f $ U S D ; o th e r w is e, th e s tu d e n t w ill b e r e s p o n s ib le fo r p a y in g th e e n tir e fir s t q u a r te r o f th e h o u s in g fe e s.

5 UCI Division of Continuing Education International Programs P.O. Box 6050 Irvine, CA Tel: Fax: Credit Card Authorization Form Student Information The payment is on behalf of the student below. Last Name (Family Name) First Name (Given Name) UCI ID# Birth Date Student s Program Term Year Method of Payment Please provide payment information. Transactions will be processed within 1-2 business days. Card Type MasterCard VISA American Express Amount $ Credit Card Number Cardholder Information Cardholder s Name As appears on credit card Expiration Date Phone Number (mm/yy) Billing Address Mailing Address Where receipt should be sent, if different from billing address Authorization I agree to pay the amount listed above on behalf of the student listed above, in accordance with the card issuer agreement. Authorizing Signature Please fax to or Mail to PO Box 6050, Irvine, CA Please do not send credit card information by as this is not a secure method of transmission. To comply with PCI DSS requirements, UCI Extension will not accept or process any credit card payment information submitted by . Date I:\DATA\STUSERV\ECPI\AGENT INVOICING\Credit Card Authorization Form.docx