Application for

Domestic andInternational

Graduate School Admission

Admission Application Deadlines:

Fall Semester ....................................................... April 1

Spring Semester ...................................... November 1

Summer Session ......................................... March 15

The University of Utah Office of Admissions Graduate Admissions Division/ International Admissions DivisionPhones/Fax: Domestic Admissions Phone: (801) 581-7283 International Admissions Phone: (801) 581-3091 Fax: (801) 585-7864

Web Address: http://admissions.utah.edu/

Email Contacts: Domestic: graduate@sa.utah.edu International: iao@sa.utah.edu

Physical Address: 250 Student Services Building

Mailing Address: 201 South 1460 East, Room 250S Salt Lake City, Utah USA 84112-9057

Why Utah?

Beyond Imagining… “I never imagined it would be so beautiful” is a comment frequently heard in The Graduate School. “My professors treated me like a colleague” is another. The fact is, Utah offers graduate students far more than they expect—a program of the highest caliber, in a place of spectacular beauty. Even with an introduction, Utah may surprise you, for, in the end, graduate study is beyond imagining. It’s discovering what happens next.

THE UNIVERSITY OF UTAH GRADUATE SCHOOL APPLICATION

1

If you are interested in applying to the S.J. Quinney College of Law, please do not use this application. You may email admissions@law.utah.edu for instructions on how to apply for Law School.

HOW TO APPLY FOR GRADUATE ADMISSIONSThe following information will assist you in applying for admission to graduate studies. Most applicants will use the online ApplyYourself application system, accessible from your academic program’s website. The ApplyYourself application system is ADA compliant.

This PDF version of our graduate admissions application is made available for use by the following applicants: An applicant, without access to the online ApplyYourself admissions

application. An applicant that is a graduate student at the University of Utah, who did not

maintain continuous registration and did not file a formal “Leave of Absence” form and now wishes to be reinstated to the same graduate program.

If you do not fall into one of the above categories, please go to www.gradschool.utah.edu. You will find a link to all graduate programs offered at the University of Utah by going to Prospective Students>Admission Requirements>Graduate Admissions. Click on your program of interest and hit GO to locate the graduate program you wish to study. You will find the link for the ApplyYourself online application at the website of each graduate program. You will also find instructions on how to apply. Because each graduate program has its own admissions procedures and deadlines, you are strongly encouraged to review the academic program’s web site or contact the department directly to determine its admissions procedures.

UNIVERSITY OFFICE OF ADMISSIONS APPLICATION DEADLINES Fall Semester . . . . . . . . . . . . . . . . . . . . . April 1 Spring Semester . . . . . . . . . . . . . November 1 Summer Semester. . . . . . . . . . . . . . March 15Applications received in the University Office of Admissions after the above deadlines will be charged a $30.00 late fee.

INSTRUCTIONS FOR APPLYING THROUGH THE PDF VERSION OF THE GRADUATE ADMISSIONS APPLICATION 1) Most academic departments have deadlines earlier than the

University Office of Admissions deadlines. Contact your department to determine their deadline. This application is due in the University Office of Admissions a minimum of thirty (30) days before the academic departmental deadline for U.S. citizens and sixty (60) days before the academic departmental deadline for non-U.S. citizens.

2) Complete the application and pay the nonrefundable application fee.

• Domestic applicants pay $55.00 • International applicants on a visa or in need of a visa pay $65 • A late handling fee of $30.00 is charged on applications received after the

University Office of Admissions deadlines. Note: Paying the late handling fee does not guarantee review of your application by the academic department.

• If you are a McNair Scholar or a Vietnamese Educational Foundation participant, please provide certification of your participation to cover the cost of your application fee.

• Your application will not be processed without the correct fee. Make your check or money order payable to the University of Utah or fill in credit card information on this application or attach your McNair or VEF certification form.. PLEASE DO NOT SEND CASH.

• ALL FEES ARE NONREFUNDABLE • FEE WAIVER REQUESTS ARE NOT GRANTED. 3) Send the application and fee, certification form, or credit card

payment form to: University of Utah Office of Admissions, Graduate Admissions Division, 201 S 1460 E Rm. 250 S, Salt Lake City, Utah 84112-9057.

4) Have one official copy of your academic transcript(s) from each college you have taken courses from (except the U of U) mailed directly to the University of Utah Office of Admissions, Graduate Admissions Division, 201 S 1460 E Rm. 250 S, Salt Lake City, Utah 84112-9057.

5) If you are a readmitting applicant, you must have one official copy of your transcript(s) mailed from only the colleges you attended since you last attended the University of Utah.

6) Failure to list ALL institutions previously attended or degrees pursued or making false or misleading statements on the application may result in denial of admissions, loss of credit and dismissal from the University of Utah.

7) If you were previously enrolled in a graduate program that you did not complete, you must provide a written statement explaining the reasons for non-completion. This should be submitted with your application to the University Office of Admissions.

8) If you are a Permanent Resident/Immigrant, you must submit a copy of your resident alien card with your admissions application.

9) NON–CITIZENS OF THE UNITED STATES must provide “proof of English proficiency”.

• The University of Utah will accept the Test of English as a Foreign Language (TOEFL) or the International English Language Testing System (IELTS) for applicants whose first language is not English.

• No application will be considered without these test results. • The official TOEFL score must be sent directly to the University of Utah Office

of Admissions by Educational Testing Service and must not be over two years old at time of admission.

• The official IELTS score can be requested from the test center where the test was administered.

• Applicants should check with their major department to determine English proficiency requirements.

• Applicants with an undergraduate or graduate degree from an accredited college or university in the U.S. may not be required to take an English proficiency examination.

• Students who have not lived in the U.S. for two or more years will be required to successfully complete the TOEFL or IELTS exam before being admitted or readmitted to the University of Utah. Previous examination scores will not be used to meet this requirement.

• The University of Utah reserves the right to require English proficiency when deemed necessary.

10) NON-CITIZENS OF THE UNITED STATES may be required to provide the following:

WELCOME TO THE UNIVERSITY OF UTAH GRADUATE ADMISSIONS APPLICATION.

THE UNIVERSITY OF UTAH GRADUATE SCHOOL APPLICATION

2

• Financial Statement - In order to issue the I-20 Certificate of Eligibility students must:

° Submit proof of financial responsibility. (For amounts needed, see Costs and Fees listed at our web site at admissions.utah.edu/international/graduate.php.)

° Financial statements become the property of the University of Utah and cannot be returned to the student.

° Financial statements are valid for only six months. If a student needs a new I-20 Certificate of Eligibility for any reason, and the financial statement on file is over six (6) months old, a new financial statement will be required.

° If an applicant is awarded financial assistance through the academic department and the financial assistance is sufficient to issue the I-20 Certificate of Eligibility, no further financial information is required.

• Sponsor’s Statement - Students who are being sponsored by their family, other individuals or agencies must have their sponsor submit a statement that they (the sponsor) will assume financial responsibility for the student’s first year expenses, including tuition and living expenses.

° In addition, the sponsor must submit a bank statement or other proof that sufficient funds are available for the student’s first year of study.

° The International Admissions Division can supply an official Affidavit of Support for the sponsor to complete. Otherwise, the sponsor’s statement must be notarized or submitted on an official document or letterhead.

° If a student is being sponsored by their Embassy, Government, or Educational Agency, a letter of sponsorship is all that is required.

11) No action will be taken until your application, transcripts, and appropriate fees or certification form have been received by the University Office of Admissions. In addition, the academic department will take no action until all university and departmental admissions requirements have been met.

12) AN OFFER OF ACCEPTANCE IS VALID ONLY FOR THE SEMESTER THE APPLICANT IS ADMITTED. If an applicant does not register for classes during his/her admitted term, the applicant must resubmit an admissions application and fee before the application deadline for the semester he/she wishes to begin. Once admitted and enrolled, graduate students are required by Graduate School policy to maintain continuous registration during the academic year of fall and spring semesters. If a graduate student must stop out, he/she should file the appropriate paperwork for an “Official Leave of Absence.” Students failing to maintain continuous registration and who have not been granted an official leave of absence must reapply for admission by submitting an application and fee to the University Office of Admissions.

ADDITIONAL INFORMATION TO ASSIST GRADUATE STUDENTS

Financial AssistanceThree categories of financial assistance are available to graduate students. • Department Assistantship and Fellowships: contact the academic department

of your intended program of interest. • Specific Fellowships and Awards: contact the University of Utah, Graduate

Fellowships Office, 201 S Presidents Circle Rm. 302, Salt Lake City, Utah 84112-9016, (801) 581-6020.

• Student Loans: contact the University of Utah, Office of Financial Aid and Scholarships, 201 S 1460 E Rm. 105, Salt Lake City, Utah 84112-9055, (801) 581-6211.

• Non U.S. Citizen Applicants should contact the academic department of your intended program of interest for information concerning financial assistance.

Housing • Single students desiring on-campus housing should contact the University

Housing & Residential Education Office at (801) 587-2002 or visit their website at www.housing.utah.edu .

• Students with family should contact the University Student Apartments at (801) 581-8667 or visit their website at apartments.utah.edu .

Disabled StudentsFor information on facilities and programs for disabled students, contact the Center for Disability Services at (801) 581-5020 (voice or TDD).

Student Health Service • Provides on-campus, low-cost, quality primary medical care to all University

students and their dependent families. • Fees are charged for most services and payment is requested at the time of

service. • PROOF OF IMMUNITY REQUIREMENT (PIR): ° All new and transfer students born after December 31, 1956, are required to

submit proof of immunity to the Student Health Service. ° Students must have evidence of immunity to or appropriate vaccinations

against measles, mumps, and rubella. ° Further information about health services provided and the PIR requirement

may be found at studenthealth.utah.edu or by calling (801) 581-6431.

University of Utah General Catalog Website: catalog.utah.eduThe Graduate School: www.gradschool.utah.eduGraduate Catalog: www.gradschool.utah.eduThe University Office of Admissions: www.admissions.utah.edu . You may track your admissions application at this website. For questions, call (801) 581-7283 (domestic applicants) or call (801) 581-3091 (international applicants).

Fees and deadlines are subject to change without notice. All documents submitted become the property of the University of Utah, and will not be released to students nor forwarded to other institutions or agencies.

THE UNIVERSITY OF UTAH GRADUATE SCHOOL APPLICATION

3

LIST OF GRADUATE DEGREE PROGRAMS OFFERED: Please use this list to answer questions #14 and 15 on the application. Listing the accurate title of your graduate program of interest is crucial in forwarding this application to the appropriate academic department. If you have questions, please call the University Office of Admissions at (801) 581-7283.

Accounting MACAnthropology MA, MS, PHDArchitectural Studies MSArchitecture MARArt History MAArt MFAAsian Studies MAAtmospheric Sciences MS, PHDAudiology AUDBiochemistry MS, PHDBioengineering MS, PHDBiological Chemistry PHDBiology MS, PHDBiomedical Informatics MS, PHDBiostatistics MSTBusiness Administration Executive MBABusiness Administration Professional MBABusiness Administration Full-time MBABusiness Administration PHDChemical Engineering MS, PHDChemistry MA, MS, PHDCity & Metro Planning MCPCivil & Envir Engg MS, PHDClinical Investigation MSCommunication MA, MS, PHDComputational Engineering & Science MSComputer Science MS, PHDComputing MS, PHDDentistry DDSEconometrics MSTEconomics MA, MS, PHDEducation, Culture & Society MA, MED, MS, PHDEducational Leadership & Policy MED, EDD, PHDEducational Psychology MA, MED, MS, MST, PHDElectrical & Computer Engineering EE, MEN, MS, PHDEnglish MA, PHDEnglish-Creative Writing MFAEnvironmental Humanities MA, MSExercise & Sport Science MS, PHDFamily and Consumer Studies MED (Early Childhood Ed.)

Film and Media Arts MFAFinance MSGenetic Counseling MSGeographic Information Science MSGeography MA, MS, PHDGeological Engineering MEN, MS, PHDGeology MS, PHDGeophysics MS, PHDGerontology MSGlobal Pathways Interdisciplinary MSHealth Promotion & Education MS, EDD, PHDHealthcare Administration MHAHistory MA, MS, PHDHuman Development & Social Policy MSHuman Genetics MS, PHDInformation Systems MSInternational Affairs & Global Enterprise MSLaboratory Medicine and Biomedical Science, MSLanguage Pedagogy MALanguages & Literature MA, PHDLatin American Studies MALinguistics MA, PHDMaterial Science & Engineering MS, PHDMathematics MA, MS, MST, PHDMechanical Engineering MS, PHDMedicinal Chemistry MS, PHDMedicine MDMetropolitan Plan, Policy and Design PHDMetallurgical Engineering MEN, MS, PHDMicrobiology & Immunology MS, PHDMining Engineering MEN, MS, PHDModern Dance MFAMolecular Biology PHDMusic MMU, PHDMusical Arts DMAMusicology MANeurobiology and Anatomy MS, PHDNeuroscience PHDNuclear Engineering MEN, MS, PHDNursing MS, PHD

Nursing Practice DNPNutrition MSOccupational and Environmental Health PHDOccupational Health MOH , MSOccupational Therapy MOT, DOTOncological Sciences MA, MS, PHDParks Recreation & Tourism MS, EDD, PHDPharmaceutics & Pharmaceutical Chemistry MS, PHDPharmacology & Toxicology MS, PHDPharmocotherapy Outcomes Research and Health Policy MS,

PHDPharmacy DPHPhilosophy MA, MS, PHDPhysical Therapy DPTPhysician Assistant Studies MPSPhysics MA, MS, PHDPhysiology PHDPolitical Science MA, MS, PHDProfessional Masters of Science & Technology Select one: Biotechnology PSM

Computational Science PSM Environmental Science PSM Science Instrumentation PSM

Psychology MA, MS, PHDPublic Administration ExMPA, MPAPublic Health MPH, MS, PHDPublic Policy MPPReal Estate Development MRDRehabilitation Science PHDScience Program MS (for secondary school teachers in

Chemistry, Mathematics, Physics)Social Work MSW, PHDSociology MA, MS, MST, PHDSpecial Education MED, MS, PHDSpeech-Language Pathology & Audiology PHDSpeech-Language Pathology MA, MSWorld Languages MA

Credit Card Payment Form

By filling out this form, I give the University of Utah permission to charge my credit card for the admissions application fee and (if necessary) the late-handling fee.

Student Name: _________________________________________ Cardholder Name: ______________________________________

Student Soc. Sec. No.: _____________________________________ Card Number: _________________________________________

Phone Number: _________________________________________ Expiration Date: ______________ Amount $ ______________

Card Type: Discover MasterCard VISA American Express

Cardholder Billing Address: ________________________________________________________________________ Zip Code: __________

Cardholder Signature _____________________________________________________________________________________________

THE UNIVERSITY OF UTAH GRADUATE SCHOOL APPLICATION

4

1. Full legal name _________________________________ Last/Family/Surname ____________________________________________ First/Given ____________________________________________ Middle

Preferred first name: ________________________________ Other names under which your academic records may be listed: __________________________________________ Last/Family/Surname, First Given, Middle

2. U. S. Social Security Number *

3. Date of Birth (Month/Day/Year) 4. Country of Birth _________________________________

5. Country of Citizenship _________________________________

6. Non-citizens of the United States, please provide the following information: Are you currently residing in the United States? Yes No If you are on a visa, what is your visa status? Check one of the following: F-1 F-2 J-1 J-2 Permanent Resident/Immigrant List Alien Registration Number: A__________________ Date Issued ___________________ (ATTACH A COPY OF YOUR PERMANENT/RESIDENT ALIEN CARD)

Have applied for Permanent Resident status or Political Asylum with USCIS Date of application ______________ Refugee

Other (please explain): _______________________________Utah High School Graduate Requesting Utah HB 144 (2002) consideration

7. Gender: Male Female

8. Ethnic Origin: Choose the one that best describes you (optional)a. Do you consider yourself to be Latina/o or Hispanic? Yes Nob. Regardless of your answer above, select one or more of the following racial

categories to describe yourself: American Indian or Alaska Native Asian Black or African American Native Hawaiian or Pacific Islander White

9. Have you ever served in the U.S. Military? Yes No

List dates of military service (mm/dd/yyyy) From: _____________ To: _____________

In what branch of the military did you serve? _____________________

Are you currently a member of the Utah National Guard or an immediate family member of someone who is a member of the Utah National Guard? Yes No

Carefully read the application instructions before filling out this form. Complete and return the application with the proper NONREFUNDABLE FEE or certification form to: University of Utah Office of Admissions, Graduate Admissions Division,201 S 1460 E Rm. 250 S, Salt Lake City, Utah 84112-9057.THIS FORM IS NOT FOR USE BY LAW SCHOOL APPLICANTS.

SELECT THE SEMESTER AND ENTER THE YEAR YOU PLAN TO START/ENROLL IN YOUR GRADUATE COURSES (Check only one)

___ Fall Semester (Aug) ___ Spring Semester (Jan) ___Summer Session (May) Year applying for ________ CHECK ALL THAT APPLY BELOW:

___ New Student without access to the online ApplyYourself application___ Readmitting Student (Previously admitted and attended a graduate program at the U of U; did not maintain

continuous registration) List U of U Student ID# ________________________

Previous dates of attendance: From ____________________ to ___________________ Term/Year Term/Year

___ Domestic Application Fee is $55.00 (Cannot be waived and is Non-Refundable)___ International Application Fee is $65.00 (Cannot be waived and is Non-Refundable)

(Applicants on a visa or in need of a visa)____ Late fee for applications received after the Office of Admissions deadline is $30.00 (Non-Refundable)___ McNair Scholar or Vietnamese Educational Foundation Certification form attached.

For Office Use Only

ID _____________________________APPL # ___________________________

Residency ____ Residency Location _________Unclear Res Ltr Sent _________ by ________

Continued on next page

*Privacy Act Notice: The University confidentially maintains all application information, including your Social Security Number, which is used routinely to facilitate document matching, verifying your identity, and expedite your enrollment and financial aid. Disclosure of your Social Security Number is voluntary, but failure to provide your Social Security Number may result in delay and confusion regarding your identity, and once admitted, could result in delay or loss of federal and state financial aid, tax credits, student loan deferments, veteran benefits, and other benefits under law.

Application Deadline Fall Spring Summer Apr 1 Nov 1 Mar 15

(Additional $30.00 late fee after the deadline)

PERSONAL INFORMATION (Please print clearly and answer all questions.)

10. Mailing Address Permanent/Home Country Address ______________________________________________ __________________________________________________ ______________________________________________ _____________________________________________ ______________________________________________ __________________________________________________ City State/Province City State/Province ______________________________________________ _____________________________________________ Country Zip or Postal Code Country Zip or Postal Code

THE UNIVERSITY OF UTAH GRADUATE SCHOOL APPLICATION

5

20. Do you claim to be a legal resident of Utah for in-state tuition purposes? Yes No21. Are you currently living in Utah? Yes No If yes, indicate how long you have currently resided in the state of Utah without an absence:

less than 12 months 12 months to 24 months 24 months to 36 months 3 years or more If you are a Utah resident, in which county do you reside? ____________________________22. If you do not consider yourself a resident of Utah, where is your state of legal residence? ______________________________________________23. Do you have a valid driver’s license? Yes No. If yes, what state issued the driver’s license? __________________________24. Indicate what you have been doing (for example, work, military, student, stay at home parent, volunteer work) and what city and state you have resided in for the past

three years. Be specific and account for all months. (If additional space is needed, please attach a separate sheet of paper.) From Month/Day/Yr To Month/Day/Yr Activity City and State ___________________ ________________ ____________________________________ ____________________________ ___________________ ________________ ____________________________________ ____________________________ ___________________ ________________ ____________________________________ ____________________________ ___________________ ________________ ____________________________________ ____________________________ ___________________ ________________ ____________________________________ ____________________________25. Parents (please list even if deceased) Father’s name _______________________________________ Mother’s name ______________________________________ Deceased Unknown Deceased Unknown Address ___________________________________________ Address __________________________________________ ________________________________________________ ______________________________________________ Telephone ( ) _____________________________________ Telephone ( ) ____________________________________ Father’s state of legal residence: _____________________________ Mother’s state of legal residence: ____________________________ How long? (YR/MM) ___________________________________ How long? (YR/MM) __________________________________

RESIDENCY FOR TUITION PURPOSES - The Office of Admissions adheres to the state law, Utah Code 53B-8-102, “Definition of resident student” to determine your initial residency classification. IF YOU FAIL TO COMPLETE QUESTIONS 20-25 ON EACH ADMISSIONS APPLICATION YOU SUBMIT, YOU WILL BE CLASSIFIED AS A NON-RESIDENT FOR TUITION PURPOSES.Residents of Utah, under the age of 25, must provide information about their parent or legal guardian. This information is required to determine residency classification. Omission of all parent/guardian information will result in classification as a nonresident.

Only U.S. citizens complete Question 2626. List in chronological order all colleges you have taken courses from, including the University of Utah, regardless of length of attendance. One official copy of transcript(s) from

each college you have taken courses from including concurrent enrollment, study abroad, correspondence, etc. (except the U of U) must be mailed directly from the institution to the University of Utah Office of Admissions. Transcript(s) must be received before your application will be considered. Please note if you are filing as a “Readmitting Student,” you must have one official copy of your transcript(s) mailed from only the colleges you took courses from since you last attended the University of Utah. If you need additional space, please attach to a separate sheet of paper.

Degree Earned Self Name of Institution Dates of Attendance and Date Reported

(DO NOT Abbreviate) City/State From (Mo/Year) To (Mo/Year) Rec’d/Expected Grade Pt. Avg. Status*___________________________ _______________________ ____________ ____________ _____________ _________ _________________________________ _______________________ ____________ ____________ _____________ _________ _________________________________ _______________________ ____________ ____________ _____________ _________ _________________________________ _______________________ ____________ ____________ _____________ _________ ______*List status at each school using the following codes: G = Graduate, S = In good standing, P = Probation, D = Suspended or dismissed, N = Nonmatriculated (not seeking a degree)Are you in good standing and eligible to return to the last college you attended: Yes NoNOTE: Failure to list ALL institutions previously attended or degrees pursued may result in denial of admission, loss of credit and dismissal from the University of Utah. If you were previously enrolled in a graduate program that was not completed, please provide a written statement explaining the reasons for noncompletion.

EDUCATIONAL HISTORY

Personal Information continued

11. I am interested in more information about on campus housing: Single student housing Family housing12. Telephone: U.S. Home: ( ) ______________________________ U.S. Cell: ( ) _______________________________________13. E-mail address: _______________________________________________________________________________________ We will use e-mail as our primary means of contacting you throughout the admissions process. Provide us with an e-mail address which you check regularly and notify us immediately should this address change.14. What graduate program are you applying to: (Select from the “List of Graduate Programs” on page three of the instructions. If your program is not found on this list, please

call the Office of Admissions at 801-581-7283 for assistance.) _____________________________________________________________15. Graduate degree for which you are applying (CIRCLE ONE ONLY) MA MAC MAR MAT MBA ExMBA PrMBA MCP MED MEN MFA MHA MMU MOH MOT MPA ExMPA MPH MPP MPS MRD MS MST MSW MUP PSM AUD DMA DNP DOT DPH DPT EE EDD MD PHD OTHER ____________________________16. Undergraduate major(s) __________________________________________________________________________________17. What is your first language?__________________________ 18. Are you proficient in any other language? Please specify: ____________________19. With whom do you make your permanent home? Father Mother Both Other What city and state: ______________________________

Continued on next page

THE UNIVERSITY OF UTAH GRADUATE SCHOOL APPLICATION

6

28. If you are currently on a visa or are requesting an I-20 Certificate of Eligibility from the University of Utah, please complete the following: a. Will you request the University of Utah to issue the I-20 Certificate of Eligibility? Yes No

In order to issue the I-20 Certificate of Eligibility students must: 1) Be accepted to the University of Utah as a matriculated (degree-seeking) student. 2) Submit proof of financial responsibility.

b. If you currently hold an F-1 Visa, what school issued your I-20? _____________________________________________ c. What date did you enter the United States? (month/day/year) _____ _____ _____ d. What is your SEVIS Identification number: _________________________________________________________ e. What date will you be released from your most recent school? (month/day/year) _____ _____ _____ f. What is your U.S. International Identification Number (IIN)? _______________________________________________29. Do you plan to change to an F-1 student visa (if you now have another type of visa)? Yes No How will you change your visa status? Leave, then re-enter the U.S. Remain in the U.S. (this option may take 6+ months).30. If you plan to bring your spouse and/or children and wish this information to be included on your I-20 Certificate of Eligibility, please list them below: Family Name First/Given Name Middle Name Date of Birth Country of Birth Country of Relationship Gender Citizenship to Student

__________________ ________________ ___________ ______________ ______________ _________ ___________ ____ __________________ ________________ ___________ ______________ ______________ _________ ___________ ____ __________________ ________________ ___________ ______________ ______________ _________ ___________ ____ __________________ ________________ ___________ ______________ ______________ _________ ___________ ____ __________________ ________________ ___________ ______________ ______________ _________ ___________ ____ __________________ ________________ ___________ ______________ ______________ _________ ___________ ____ __________________ ________________ ___________ ______________ ______________ _________ ___________ ____

Students currently holding the J-1 Exchange Visa should send a copy of their DS-2019 to the International Center, University of Utah, 200 S Central Campus Drive, Room 410, Salt Lake City, Utah 84112-9113 USA.

ONLY NON-CITIZENS OF THE U. S. SHOULD COMPLETE QUESTIONS 28 THROUGH 30.

Continued on next page

Educational History continued

Only Non-citizens of the U.S. complete Question 27

27. List all educational institutions attended, beginning with the first year of primary school and ending with the last year of education (including the school in which you are currently enrolled, if any). Print the name of each certificate, diploma, or title earned in English and in the original language. Do not abbreviate or use initials. Add addi-tional pages if necessary. Unless the school attended routinely issue transcripts in English, official school records must be submitted in the original language with official English translations. One official copy of transcripts from each school you attended (except the U of U) must be sent directly from the institution attended to the University Office of Admissions. Transcript(s) must be received before your application will be considered.

Name of Institution Date of Attendance Name of Diploma Year of Graduation (DO NOT Abbreviate) City & Country From/To Month/Year or Certificate (or expected date)

Primary/Secondary Schools ____________________________ ________________ ____________________ ______________________ _____________ ____________________________ ________________ ____________________ ______________________ _____________ ____________________________ ________________ ____________________ ______________________ _____________ ____________________________ ________________ ____________________ ______________________ _____________ ____________________________ ________________ ____________________ ______________________ _____________

Post Secondary Schools/Universities ____________________________ ________________ ____________________ ______________________ _____________ ____________________________ ________________ ____________________ ______________________ _____________ ____________________________ ________________ ____________________ ______________________ _____________ ____________________________ ________________ ____________________ ______________________ _____________ ____________________________ ________________ ____________________ ______________________ _____________ ____________________________ ________________ ____________________ ______________________ _____________ ____________________________ ________________ ____________________ ______________________ _____________NOTE: Failure to list ALL institutions previously attended or degrees pursued may result in denial of admission, loss of credit and dismissal from the University of Utah. If you were previously enrolled in a graduate program that was not completed, please provide a written statement explaining the reasons for noncompletion.

THE UNIVERSITY OF UTAH GRADUATE SCHOOL APPLICATION

7

APPLICATION FEES, DEADLINES, AND ADMISSIONS REQUIREMENTS ARE SUBJECT TO CHANGE WITHOUT NOTICE. All documents submitted become the property of the University of Utah, and will not be released to students or forwarded to other institutions or agencies.ANY FALSE OR MISLEADING INFORMATION PROVIDED IN THE SUPPORT OF THIS APPLICATION MAY RESULT IN DISMISSAL FROM GRADUATE STUDIES AT THE UNIVERSITY OF UTAH.ANY PERSON KNOWINGLY MAKING A FALSE OR MISLEADING STATEMENT IS GUILTY OF A CLASS B MISDEMEANOR AND IS PUNISHABLE PURSUANT TO UTAH CODE ANNOTATED SECTION 76-8-504.

All the answers I have given in this application are complete and accurate to the best of my knowledge. If admitted, I agree to observe all the rules and regulations of the University of Utah. I understand I will be responsible for payment of all amounts I owe the University, i.e., tuition, fees, fines, rents, parking citations, etc. I agree to make payments promptly and acknowledge that payments will be applied to charges in the order determined by the University. I also agree to pay reasonable collection and/or attorney’s fees necessary to collect any outstanding balance on my account(s).

Applicant’s Signature ______________________________________________________ Date ____________________________

ALL APPLICANTS SHOULD CAREFULLY READ AND COMPLETE THE FOLLOWING SECTIONS

DIRECTORY INFORMATION relating to a student is considered to be public information unless the student requests that it be kept confidential. DIRECTORY INFORMATION CONSISTS OF: • Student’s Name • Address • Telephone Number • Student ID Number • Class Standing • Field of Study • Participation in officially recognized activities or sports • Weight and Height of Members of Athletic Teams • Dates of Attendance • Degrees and Awards received • Most recent previous educational agency or institution attended • Email Address • Enrollment Status. A FORM TO RESTRICT DISCLOSURE OF DIRECTORY INFORMATION IS AVAILABLE AT THE REGISTRAR’S OFFICE AT registrar.utah.edu

NONDISCRIMINATIONThe University of Utah complies with all state and federal nondiscrimination and equal opportunity law. University of Utah admission policies apply to all prospective students without regard to race, color, religion, national origin, sex, age, status as a disabled individual, sexual orientation, gender identity/expression and status as a protected veteran. The following University employee has been designated to handle inquiries regarding the non-discrimination policies and grievance procedures: Manager, Office of Equal Opportunity & Affirmative Action, 201 So. Presidents Circle, Rm 135, Salt Lake City, UT 84112, (801) 581-8365 (voice/tty), or online at www.oeo.utah.edu.

Rev 3/2013

GRADUATE ADMISSIONS CHECKLIST University Office of Admissions Application Deadline: Fall Semester (Apr 1); Spring Semester (Nov 1); Summer Session (Mar 15). Contact the academic department directly to determine its admission procedures and deadlines. All materials required only by the academic department

should be sent directly to the academic department. Complete all portions of the graduate admissions application. Include a copy of your McNair Scholar or Vietnamese Educational Foundation Certification form. Include a check, money order, or credit card information for the application fee. Remember, these FEES ARE NONREFUNDABLE and FEE WAIVER REQUESTS ARE NOT

GRANTED. Fees are subject to change without notice. Please do not send cash. Send the graduate admissions application, fee or certification form, and transcripts to: UNIVERSITY OF UTAH, OFFICE OF ADMISSIONS, GRADUATE ADMISSIONS

DIVISION, UNIVERSITY OF UTAH, 201 S 1460 E ROOM 250S, SALT LAKE CITY UT 84112-9057. Have one official copy of academic transcript(s) from each college or university you have taken courses from (except the U of U) mailed directly to the Office of

Admissions, Graduate Admissions Division. If you were previously enrolled in a graduate program that you did not complete, you must provide a written statement explaining the reasons for non

completion. This should be submitted with your application to the Office of Admissions. Send a copy of your permanent/resident alien card, if applicable, with the admissions application. TOEFL/IELTS Test – see previous instructions in the application regarding who must submit this test information. Financial Statement – If I-20 is required, please see previous instructions in the application regarding this documentation.

For more information on the Office of Admissions or to track your application go to: www.admissions.utah.edu

ACCOMMODATIONS FOR STUDENTS WITH DISABILITIESThe University complies with the Americans With Disabilities Amendments Act of 2008 (ADA) and Section 504 of the Rehabilitation Act of 1973. Requests for accommodation or auxiliary services can be made by contacting: Director, Center for Disability Services, 200 S Central Campus Drive, Room 162, Salt Lake City, UT 84112-9107, (801) 581-5020 (voice/TDD), or online at disability.utah.edu

Additional comments you consider pertinent/important to this application: _____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________