UCI Student Information Sheet
*All your personal information needs to match your passport
Personal Information
Name First Name: *
Last Name:
*
Other Names Used: First Name:
Last Name:
Date of Birth: *
Place of Birth:
*
Gender: Male Female
Nationality:
*
National ID Number: *
(Please input 00000 if you do not have an ID number)
Passport Number:
*
(Please input 00000 if you do not have a passport)
How did you hear this program: *
Home Address: *
Zip:
Mailing Address: *
Zip:
Cell or Home Phone Number: *
Email:
*
Have you ever been in the USA? Yes No
When:
Visa type:
Have you ever been refused US visa? YesNo
When:
Visa type:
Family Information
          Do you have any relatives in the US?   Yes     No
  Guardian Or Relatives Name: Guardian Or Relatives Address: Guardian Or Relatives Phone Number:
Father's Name: * Contact Number: *
Job Title: Email:
          Has he ever been in the USA?   Yes No
When: Visa type:
          Has he ever been refused US visa?   Yes No
When: Visa type:
Mother's Name: * Contact Number: *
Job Title: Email:
          Has she ever been in the USA?   Yes No
When: Visa type:
          Has she ever been refused US visa?   Yes No
When: Visa type:
Academic Information
GPA @ current school: * Current School: *
School Address:
* Grade Year: *
Major:
*
English Proficiency Test:
Score: * Test Date : *
GRE: GMAT :
Session:
Course CCN:
  
 
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