2017 WU Application - MSM - CULS

Admissions Application

(A $30.00 application fee must accompany this application)

SECTION I: PERSONAL INFORMATION

First Name*

*As seen on legal documents

Last Name*

*As seen on legal documents

Middle Name

*As seen on legal documents

Do you have any previous names?*

Yes No

Previous First Name*

Previous Last Name*

Previous Middle Name

Date of Birth*

Home Phone

Mobile Phone*

Email*

HOME ADDRESS

Street Address*

Unit number

City*

State or Province*

Zipcode*

Country*

Is your mailing address the same as above?*

Yes No

MAILING ADDRESS

Mailing Street Address*

Mailing Unit Number

Mailing City*

Mailing State or Province*

Mailing Zipcode*

Mailing Country*

Dependent #1

Dependent 1 First Name*

Dependent 1 Middle Name

Dependent 1 Last Name*

Dependent 1 Gender*

Male Female

Dependent 1 Relationship*

Dependent 1 Date of Birth*

Dependent 1 Passport Number

Dependent 1 Country of Birth*

Would you like to add a second dependent?*

Yes No

Dependent #2

Dependent 2 First Name*

Dependent 2 Middle Name

Dependent 2 Last Name*

Dependent 2 Gender*

Male Female

Dependent 2 Relationship*

Dependent 2 Date of Birth*

Dependent 2 Passport Number

Dependent 2 Country of Birth*

Would you like to add a third dependent?*

Yes No

Dependent #3

Dependent 3 First Name*

Dependent 3 Middle Name

Dependent 3 Last Name*

Dependent 3 Gender*

Male Female

Dependent 3 Relationship*

Dependent 3 Date of Birth*

Dependent 3 Passport Number

Dependent 3 Country of Birth*

Would you like to add a fourth dependent?*

Yes No

Dependent #4

Dependent 4 First Name*

Dependent 4 Middle Name

Dependent 4 Last Name*

Dependent 4 Gender*

Male Female

Dependent 4 Relationship*

Dependent 4 Date of Birth*

Dependent 4 Passport Number

Dependent 4 Country of Birth*

Would you like to add a fifth dependent?*

Yes No

Dependent #5

Dependent 5 First Name*

Dependent 5 Middle Name

Dependent 5 Last Name*

Dependent 5 Gender*

Male Female

Dependent 5 Relationship*

Dependent 5 Date of Birth*

Dependent 5 Passport Number

Dependent 5 Country of Birth*

SECTION V: EDUCATION

Please indicate whether you have earned a high school diploma, passed the General Educational Development (GED) test, or completed homeschooling at the secondary level.*

Yes No

Expected Completion Date*

Attach Transcript

No File Chosen

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Type Completed*

High School Diploma / Higher Secondary School GED/Certificate Homeschooled Work Readiness Certificate Certificate or equivalent Other

Institution Name*

High School Address*

High School Country*

High School GPA*

High School Date of Completion*

Have you taken courses at a community college, college or university, technical or trade school, or other higher education institution?*

Yes No

College Institution Name*

College Address*

College Country*

Credits Completed*

Area of Study*

Degree or Certificate Earned

Degree Type Earned*

Date Attended From*

Date Attended To*

College GPA*

Would you like to add any additional colleges, universities or institutions?*

Yes No

Additional University Information

Additional College Institution Name*

Additional College Address*

Additional College Country*

Additional College Credits Completed*

Additional College Area of Study*

Additional College Degree or Certificate Earned

Additional College Degree Type Earned*

Additional College Attended From*

Additional College Attended To*

Additional College GPA*

Would you like to add a third college, university or institution?*

Yes No

Additional University Information - 2

Additional College 2 Institution Name*

Additional College 2 Address*

Additional College 2 Country*

Additional College 2 Credits Completed*

Additional College 2 Area of Study*

Additional College 2 Degree or Certificate Earned

Additional College 2 Degree Type Earned*

Additional College 2 Attended From*

Additional College 2 Attended To*

Additional College 2 GPA*

Would you like to add a fourth college, university or institution?*

Yes No

Additional University Information - 3

Additional College 3 Institution Name*

Additional College 3 Address*

Additional College 3 Country*

Additional College 3 Credits Completed*

Additional College 3 Area of Study*

Additional College 3 Degree or Certificate Earned

Additional College 3 Degree Type Earned*

Additional College 3 Attended From*

Additional College 3 Attended To*

Additional College 3 GPA*

PROFICIENCY TESTS

Please provide proficient standard exams you have completed

SAT TOEFL PBT iBT IELTS Eiken Eng Proficiency CEFR SLC Exam HSEB Exam

SAT score*

Test Date*

TOEFL PBT score*

Test Date*

iBT score*

Test Date*

IELTS score*

Test Date*

Eiken Eng Proficiency score*

Test Date*

CEFR score*

Test Date*

SLC Score*

Test Date*

HSEB Score*

Test Date*

I do not have any proof of English proficiency and would like to request to take an English Proficiency exam (CPE) administered by Westcliff University

Request for CPE Exam

Test Result*

No File Chosen

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Please see our qualifications for English Proficiency for more details.

Does your employer sponsor your tuition?*

SECTION VI: PROFESSIONAL EXPERIENCE

Are you currently employed?*

Yes No

CURRENT EMPLOYMENT

Current Employer*

Job Title*

Supervisor*

Date of Employment From*

Current Pay Rate* $

Denominated in U.S. dollars

Pay Type*

Employment Industry*

Number of hours of employment*

Do you plan to change work hours upon enrollment?*

Yes No

Indicate how many hours you plan to work while attending Westcliff*

Do you have previous employment experience?*

Yes No

PREVIOUS EMPLOYMENT

Company Name 1*

Job Title 1*

Supervisor 1*

Date of Employment From 1*

Date of Employment To 1*

Pay rate 1* $

Denominated in U.S. dollars

Pay Type 1*

Employment Industry 1*

Would you like to add additional work experience?*

Yes No

PREVIOUS EMPLOYMENT

Company Name 2*

Job Title 2*

Supervisor 2*

Date of Employment From 2*

Date of Employment To 2*

Pay rate 2* $

Denominated in U.S. dollars

Pay Type 2*

Employment Industry 2*

Would you like to add additional work experience?*

Yes No

PREVIOUS EMPLOYMENT

Company Name 3*

Job Title 3*

Supervisor 3*

Date of Employment From 3*

Date of Employment To 3*

Pay rate 3* $

Denominated in U.S. dollars

Pay Type 3*

Employment Industry 3*

SECTION VII: REFERRAL

How did you hear about Westcliff University*

Referral Online Career/Job Fairs College Fairs Other

Referred by*

Referral Email

Referral Code (if applicable)

Where did you hear about us online?*

Please specify which career/job fair you attended*

Please specify which college fair you attended*

Other: Please specify*

SECTION VIII: Form Upload (OPTIONAL)

Attach transcript

No File Chosen

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Addtional Transcripts

No File Chosen

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Copy of Diploma / Certificates

No File Chosen

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Transcript English Translation

No File Chosen

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Evidence of English Proficiency

No File Chosen

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Additional documents

No File Chosen

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Copy of Passport

No File Chosen

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Copy of Visa

No File Chosen

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Bank Statements

No File Chosen

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Additional Bank documents

No File Chosen

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EAD Card

No File Chosen

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I20 copy

No File Chosen

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Affidavit of Support

No File Chosen

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SECTION IX: CERTIFICATION

I hereby affirm that the information provided by me in this application is true and correct, and that there are no omissions or misstatements in my application. I consent to Westcliff University (the "University") taking one or more of the following actions upon discovery, at any time, of any such omission or misstatement of mine in this application: (1) Voiding of my admission & registration to the University; (2) Voiding of credit(s) for course work completed at the University; and (3) Distribution of information relating to such omissions and/or misstatements to other academic institutions, governmental agencies, and other third parties.

I understand that, if admitted to Westcliff University, I must abide by the rules and regulations of the University.

I have received and read a copy of the Westcliff University Catalog, bulletin listing, schedules of fees, and course description.

By entering my FULL NAME below, I agree and attest to the above certification:

Signature*

Full Name*

Date / Time*

SECTION X: APPLICATION FEE

If you have selected to pay your application fee by check, cashiers check or money order, please print this application and mail it with your payment to:

Westcliff University
17877 Von Karman Ave, Suite 400
Irvine, CA 92614
(888) 491-8686

All payment information on our site is securely stored and processed. You are protected by the security features of our website.

Application Fee

SECTION I: PERSONAL INFORMATION

HOME ADDRESS

MAILING ADDRESS

SECTION II: CITIZENSHIP

Dependent #1

Dependent #2

Dependent #3

Dependent #4

Dependent #5

SECTION III: DEMOGRAPHIC INFORMATION

SECTION IV: INTENDED CURRICULUM

SECTION V: EDUCATION

Additional University Information

Additional University Information - 2

Additional University Information - 3

PROFICIENCY TESTS

SECTION VI: PROFESSIONAL EXPERIENCE

CURRENT EMPLOYMENT

PREVIOUS EMPLOYMENT

PREVIOUS EMPLOYMENT

PREVIOUS EMPLOYMENT

SECTION VII: REFERRAL

SECTION VIII: Form Upload (OPTIONAL)

SECTION IX: CERTIFICATION

FERPA CONSENT TO RELEASE EDUCATIONAL RECORDS

PLEASE READ:

SECTION X: APPLICATION FEE