The University of Texas at Arlington · The University of Texas at Arlington . ... This is used to ensure accurate matching of documents and timely ... withdrawal of any offer of

The University of Texas at Arlington

Office of Undergraduate Admissions – (817) 272-MAVS (6287) – (817) 272-3435 (FAX) Common Application for International Admission to Texas Public Universities

Complete in ink. In order to be processed, your application must be signed, dated and accompanied by a $50 application fee. Permanent Residents with foreign credentials should complete a U.S. Citizen application and submit a $50 application fee. This fee covers the cost of processing your application and is non-refundable. Return to:

The University of Texas at Arlington Phones: Office of Admissions, Records & Registration 817-272-MAVS (6287) – Office Box 19114 817-272-3435 – FAX Arlington, Texas 76019-0114 [email protected] – E-Mail www.uta.edu – Website

A. NAME AND ADDRESS INFORMATION 1. Social Security Number: 2. Date of Birth (Month/Day/Year): (Optional: This is used to ensure accurate matching of documents and timely processing. You will be assigned an identification number if you do not provide a social security number.) 3. Full, Legal Name: Last/Family First Middle Suffix (Jr., etc) 4. Other names which may appear on academic records: 5. Gender: Male Female 6. Place of Birth: City State Country 7. Foreign Address: Apt # City: (Number and Street) (Students currently residing in the U.S. and planning to attend UTA on an F-1 visa must provide a foreign address in order to be issued an I-20) State: Zip/Postal Code: Country: Permanent Phone: ( ) 8. Mailing Address: Apt # (Number and Street) City: State: Zip/Postal Code: Country: Daytime Phone (if different from permanent phone): ( ) Current Phone (if different from permanent phone): ( ) Current Address Good Until: (Date) Emergency Contact Name: Phone: Relationship: E-Mail Address: FAX Number, if available: __________________

You may be entitled to know what information The University of Texas at Arlington (UT Arlington) collects concerning you. You may review and have UT Arlington correct this information according to procedures set forth in UTS 139. The law is found in sections 552.021, 552.023 and 559.004 of the Texas Government Code.

Application continued on Page 2

http://www.uta.edu/


Name: ______________________________________ Social Security Number: __________________________ Page 2 Residency Statement (Please answer all questions. Use n/a if the question does not apply to you.)

1. (a) Are you a U.S. citizen? Yes____ No____ If “No,” of what country are you a citizen? _______________________ (b) If you are not a citizen, do you hold Permanent Residence status (valid I-551) for the U.S.? Yes____ No____ If “Yes,” date permanent resident card* issued: ___________ (MM/DD/YYYY) Number: ___________________ If “No,” has INS allowed you to file the I-485* or to have an I-130* or I-140* filed on your behalf? Yes ____ No ____ (c) Are you a foreign national here on a visa? Yes ____ No ____ If “Yes,” what type of visa* do you hold? ___________

*Enclose a copy of documentation (card, receipt notice, I-94, or passport documentation).

2. List your address or addresses for the last two years: Street Address City State From (Month/Year) Thru (Month/Year) ________________________________________________________________________________________________________________________________________________________________________________________________________________

3. List employers and employment dates for the last two years (full-time work only): Employer: ______________________ Location: ____________________________ From: ____________ Thru: _____________ Employer: ______________________ Location: ____________________________ From: ____________ Thru: _____________

4. Are you a resident of Texas? Yes____ No____ If “No,” of what state are you a resident? ___________________________ (If you are not a resident of Texas, skip to question 8.)

5.(a) Did your parent or court-appointed legal guardian claim you as a dependent for U.S. federal income tax purposes for the tax year preceding your registration? Yes____ No____

(b) Will this person claim you as a dependent for the current tax year? Yes____ No____. If you checked “Yes” for (b) (claimed as a dependent), answer question 7. If you checked “No” for (b) (self-supporting and not claimed as a dependent), answer question 6.

6. If you are self-supporting and not claimed as a dependent on your parent’s or court-appointed legal guardian’s most recent tax return, please answer the following:

(a) How long have you lived in Texas? Years______ Months______ (b) Previous state or country of residence: _______________________________ (c) If you came here within the past five years, why did you move to Texas? Education _____ Employment _____ Military Assignment _____ Other (explain) __________________________________ (d) Are you currently on active military duty assignment in Texas? Yes____ No____ If “Yes,” provide proof. (e) What state is your home of record with the U.S. Armed Forces? ________________________

7. If your parent or court-appointed legal guardian will claim you as a dependent for the current tax year, please answer the following (if court-appointed legal guardian, copies of guardianship papers must be provided):

(a) Name of person who will claim you as their dependent: ________________________________________ (b) Relationship to self: Parent____ Court-Appointed Legal Guardian____ (c) How long has this person resided in Texas? Years______ Months______ (d) Previous state or country of residence: ___________________________________ (e) If this person came here within the past five years, why did this person move to Texas? Education _____ Employment_____ Military Assignment_____ Other (explain) __________________________________ (f) Is your parent or court-appointed legal guardian currently on active military duty assignment in Texas? Yes____ No____ If “Yes,” provide proof. (g) What state is the home of record with the U.S. Armed Forces for your parent or court-appointed legal guardian? __________ (h) Is this person a U.S. citizen? Yes____ No____ If “No,” does this person hold a valid I-551 (Resident Alien) card? Yes____ No____

If “Yes,” enclose a copy of both sides of the card.

8. OATH – Failure to complete, sign and date this portion will result in a nonresident classification. I understand that information submitted herein will be relied upon by the University of Texas at Arlington (UTA) to determine my residence status for tuition purposes. I authorize UTA to verify the information I have provided. I agree to notify the proper UTA officials of any changes in the information provided. I certify that the information on this application is complete and correct, and I understand that the submission of false information is grounds for rejection of my application, withdrawal of any offer of acceptance, cancellation of enrollment, or appropriate disciplinary action. Signature ________________________________________________ Date _______________________



Name: ______________________________________ Social Security Number: __________________________ Page 3

B. EDUCATIONAL DATA 15. Expected Semester of Entry: Year_____ Fall_____ Spring_____ Summer I______ Summer II______ Mini/Short Semester_____ 16. You are applying as a (check appropriate responses below):

Freshman _____ Transfer _______ Transient (guest) ___________ Former UTA student______________ Non-degree seeking _______ Last term and year attended:_______ Last term and year attended: ________ Seeking second bachelor’s degree ______ _______ ________

17. To which college of the University are you applying? All new students will be considered pre-majors until accepted into an academic major and will be advised by their respective academic component. Undeclared majors will be advised by the University Advising Center. Architecture Business Administration Education Engineering Liberal Arts Nursing Science Social Work Undeclared 18. Which major do you plan to pursue? 19. Do you plan to: A) Seek a bachelor’s degree at UTA? Yes No C) Pursue an allied health career program at UTA? Yes No ______

B) Pursue a pre-law program at UTA? Yes No D) Pursue a pre-med program at UTA? Yes ____ No ______ 20. Will you seek teacher certification? Yes No If Yes, Elementary Secondary All-Level 21. Will you have earned a baccalaureate degree by the time you plan to enroll? Yes No Granting Institution Date conferred _______ University/College City State Country Month/Year 22. Are you currently on academic suspension from a college or university? Yes _________________ No ___________ C. ACADEMIC BACKGROUND 23. Are you currently enrolled in an English language program? Yes No

If yes, list school name and address. School Address

24. List high schools (secondary), including pre-college or pre-university, you have attended. Please include the school, if any, you are currently attending. Use additional paper, if necessary.

Name of School Location Mo/Yr of Enrollment Graduation/Type of Certificate / to / / to / / to / 25. If you have not graduated, give the graduation date you anticipate completing secondary school. 26. Please check each test you have taken or plan to take.

SAT I TOEFL OTHER

Test date: / Test date: / Type: Month Year Month Year

Test date: / Test date: / Test date: / Month Year Month Year Month Year

Have scores been sent to UTA? UTA’s Institution Code is 6013. (SAT I) Yes No (TOEFL) Yes No (OTHER) Yes No THEA (Texas Higher Education Assessment) All students entering a state institution of higher education must complete the Texas Success Initiative (TSI) requirement before they can register for courses. To Inquire about TSI status contact the Office of Admissions at 817-272-6287 or go to www.uta.edu/admissions/successinitiative/index.php for detailed information. To register for the THEA, please contact Assessment Services at 817-272-3670 or visit their web site at www.uta.edu/assessment.

http://www.uta.edu/assessment


Application continued on Page 4 Name: ______________________________________ Social Security Number: __________________________ Page 4 D. YOUR COLLEGIATE EDUCATIONAL DATA Transfer students and high school students who have taken or are taking college work must complete this section. 27. Have you ever applied to or been previously enrolled at The University of Texas at Arlington? Yes No 28. List the name and location of the college, university (post-secondary) or vocational/technical school you are now attending.

Name of Institution City/State/Country Date Attended Expected Date of Graduation 29. List all colleges, universities or vocational/technical schools you have attended, regardless of duration. Contact each school and request that an

official transcript be sent to The University of Texas at Arlington. Failure to list all colleges will be considered an intentional omission and may lead to enforced withdrawal of your application or dismissal from The University of Texas at Arlington. An official transcript/mark-sheet from each college listed must be submitted. If your transcript has been issued in any language other than English, both an official transcript in your native language and an official English translation must be submitted

Name of Institution

Location (City/State/Country)

Mo/Yr Enrollment

Semester/Quarter Units Completed

Graduation/ Type of Certificate

/ to / / / to / / / to / / / to / / / to / / . 30. Have you ever been placed on non-academic probation or been dismissed or suspended from another college or university for non-academic reasons, or is a disciplinary complaint currently pending against you at another college which might result in discipline if you are found guilty? Yes (if yes, please attach a separate letter of explanation) No ________ DESIGNATED REPRESENTATIVE The Family Rights and Privacy Act of 1974 prohibits a university from releasing information to anyone other than the student. If you wish to have someone discuss your file with this office, please list their name and address on this line. Should a representative complete any part of the application with inaccurate or incomplete information, the applicant will be held responsible. (Name of Representative) (Address) (Phone Number) Signature of Applicant Date OATH I certify that the information I have provided is complete and correct to the best of my knowledge. If my application is accepted, I agree to abide by the policies, rules and regulations at any school to which I am admitted. I authorize the college/university to verify the information I have provided. I further understand that the information submitted herein will be relied upon by the officials of the University in determining my admission and residence status and that the submission of false information is grounds for rejection of my application, withdrawal of acceptance, cancellation of enrollment, and/or disciplinary action. I authorize the University to electronically access my Texas Higher Education Assessment (THEA) test results. Signature Date




Name: ______________________________________ Social Security Number: __________________________ Page 5 ACADEMIC BACKGROUND We wish to obtain a detailed chronological record of your educational experience from the elementary level to the present. Please carefully complete the following table. Column 1 – These are the actual years you attended school. The first year is number 1, second year number 2, etc. Please account for every year.

Allow one line for each year. Column 2 – On each line write the appropriate calendar year for every school year attended. Column 3 – Write your age. If you were 6 years old when you attended school for the first time, write 6 on the first line. Continue by writing the correct age for each

grade attended. Column 4 – For each school year enter the standard grade, form, class, sixieme, cinquime, sexta, or the appropriate name of the class or level attended that year. Column 5 – Write the kind of school attended such as Kindergarten, Elementary, Grundschule, Volkschule, Mittelschule, Gymnasium, Lycee, Colegio, Ecole Supieur,

Secondary School, Grammar School, Teacher’s College, University, etc. Column 6 – Write the city and country location of the school. Column 7 – Write the name of any examination(s) passed or certificate(s) obtained at the end of that school year. For example, if high school was completed at the end of the twelfth year in school, on the line write: GCE, Reifezeugnis, Artium, Studentereksamen, Bachillerato, Baccalaureat, etc.

Year

in School

Calendar

Year 19__ to 19__

Your Age

Class Level

Kind of School

Elementary, Secondary,

University, etc.

Location

Certificates, Diplomas,

Degrees Earned

1st 2nd 3rd 4th 5th 6th 7th 8th 9th

10th 11th 12th 13th 14th 15th 16th 17th 18th

Please submit this application in person to UTA Office of Admissions, Records & Registration, EE Davis Hall Room #110, 701 So. Nedderman Dr. or mail the completed applications to UTA Office of Admissions, Records & Registration, Box 19114, Arlington TX 76019-0114. Thank you!


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The University of Texas at Arlington · The University of Texas at Arlington . ... This is used to ensure accurate matching of documents and timely ... withdrawal of any offer of