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APPLICATION FOR {)MISSION


For International Students
Pleaseptint yoD Infotuarior cteulr @d a N (30) dolslor ptk6si.E

UNI'ERGRAI'UATE:
A?}LICANTS MUST SI]BMIT ORIGINAI AND OMCIAL
EVIDENCE OF ACADEMIC BACKGROI]ND AND/OR B.S: tr COMPUTERSCIENCE
RELEVANTWORK EXPERIENCEOFA}PLICANT tr MAT{AGEMENTSTUD]ES
3. FOR APPLICANTSENTERING CTU'S SILICON VALLEY B.A: E HUMANITIES
CAMPUS AND NEED TO BE ISSTJEDAN I.20. BANK
FINANCL{L STATEMNETS MUST BE SUBMITTED GRADUA'IT:
SHO\4NG ADEQUATE FINANCIAL RESOURCESO,E. A M.S 'I COMPUTERENGINEERING
MINIMIJM BALANCE oF szz,soo ton NLqNarli)NaL
STUDENTS). D SOFTWAREENG]NEERING
tr ELECTRICALENGINEERING
IF APPLICABLE RESULTS OF STANDARD
EDUCATIONA], TESTS, SUCH AS TOEF.LAND IELTS, tr IIEAI,THCAREMANAGEIIGNT
SHOULDBE SENTTO A CTU AUTHORZED AGENT OR
tr ENGINEERINGMANAGEMENT
DIRTCTLYTO CTU.

tr MBA
tr CONCENTRATION

STIIDENTIS PERSONAL AND 'ONTACT INFORMA'TION

SEX P4!,I trF

AREYOUCURRENTLY
ONa' grd, o no , trOTHERSTATUS ( rvB,R)
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trNEED CIiANGE OF STATUS

NAME

ADDRESS.

(STAT!/PRO!'INCE) AL CODE) (couNTRr)


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COI'NTRY OF BIRI-IJ COT'NTRYOF CTT\ZENSHIP

SOC]ALSECURITYNUMBER PASSPORT
NTIMBERDRryERS LICENSENIIMBER

HOME PHONENI]MBER

INTERNATIONALPERMANENTADDRESSEequircd):

Hill Iae, Slite 400, CIar4 CA -95054Tet 408-689-2275,


Fd: 408-282-3501,
M.ctunieors
coNTACT (MOBILE): HOME:
EMERGENCYCO\"TACT I /-)
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LIST IN CTIRONOLOGICAL OR.DERALL COLLEGES OR I]NI}IERSITIES YOU EAVE AITENDEI':

NAME &LOCATION I'IELD OF STUDY FROM T'ATE TO DATE DEGREE


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EMPLOYMENT EISTORY (IF A?PLICABLE)

COMPANY NAME ADDRESS INCLUSI}'E DAITS

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REFERXNCES:

NAME AI\'D TITLE ADDRXSSAND EMAIL TELEPEONE NO,

NONDISCRJMINATIONPOLICY:
cru DOESNor DISCRIMINATE oN TIIE BASIS oF RACE, colori, NATI0NAL oR ETHMC ORIGIN. sEX MARITAL
srATUs,
SEXJAL.PRET-ERENCE,
VETERAN'SSTATUS,TIANDICAP,DISABT TY, NUTOOW, ON ACE NI rrII ADMINISTRATIONOFANY
OF ITS EDUCATIONALAND ADMISSION POLICIES,SCrrOr,ONSrNS,rCr.rOWSrU, PROGRAMS,OR ANY OTIIER
SCHOOL
POLICIESAND PROGRAMS.

APPLICANT'S CERITICATTON:
I CERT]TY TII{T THE MATERL{I-S I ITAVE GTVEN ON THIS APPLICATION FROM ARE TRUE TO THE BEST
OF MY
KNOWLEDGE,I UN'DERSTANDTHAT I SHOULDARRANGEFOR OF!.ICNI TNEITSCNNTSib tsE SENTDIRECTLYFROM
EACH COLLEGEruNIVERSITYI TIAVEATTENDED,AND TIIAT SUCHTMNSCRJPTSSECOTD TIS PTOPCIiTY
OT CTU.
TIIE APPLICATION FEf, OF S8O.OO
MUST ACCOMPAITYTHIS A?PLICATION. THIS FEE IS NOT REF(JNDABLE.

REFERREDBY: STUDEND:
OTHER:

SIGNED(STUDENT):

FOROFFICEUSEONLY:
DATE ACIION BY

2953BunkerHill Iee, Snire400,Sera Clar4 CA -95054Tet: 4OE-68q'275,Fut 40a-2aL350t.vw.chDi!.o*

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