Office of Study Abroad - Center for Global Education

Print Form
Office of Study Abroad
Tulane University, 7008 Zimple Street, New Orleans, LA 70118, USA
Phone: (504) 865-5339
Fax: (504) 862-8765
CIS Exchange Student Application
cis@tulane.edu
Student Information
PLEASE PRINT CLEARLY.
FILL OUT AND TURN IN THE COMPLETED APPLICATION TO THE INTERNATIONAL OFFICE AT
YOUR HOME UNIVERSITY.
Student name (Last/Family Name, First Name, Middle Name, Jr., etc.)
_____________________________________________________________________________________________
Prefer to be called: __________________________________
Male
Female
Please check here to indicate your Home University.
Universidad de Belgrano, Buenos Aires, Argentina
Université Claude Bernard, Lyon 1, France
Université Lumière, Lyon 2, France
Université Paris Sorbonne – Paris IV, France
Brandenburg Technical University of Cottbus, Germany
Darmstadt University of Technology, Darmstadt, Germany
Friedrich-Schiller-Universität, Jena, Germany
University of Hamburg, Germany
Universidad Francisco Marroquin, Guatemala
University of Malta, Msida, Malta
Royal Holloway University of London, UK
University of East Anglia, Norwich, UK
University of Sussex, Brighton, UK
I am applying to Tulane University for:
I plan to begin in:
One Semester
Fall 200__
Full academic year
Spring 200__
Area(s)
of
academic
interest
/
Main
subject
/
Major:
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Coursework
you
wish
to
pursue
at
Tulane
University:
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Permanent
address
(number
and
street,
city
or
town,
ZIP
/
post
code,
country):
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Mailing address (if different) (number and street, city or town, ZIP / post code, country)
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Use mailing address until (date): __________________________________________________________________
Permanent home telephone (country code - area code - number): _______________________________________
Current telephone (if different) (country code - area code - number): ____________________________________
E-mail address: ________________________________________________________________________________
Date of birth (month - day - year):_________________________________________________________________
City of birth, Country of birth:___________________________________________________________________
Country of Citizenship: _________________________________________________________________________
If you are a dual citizen, please indicate which passport you will use to apply for your student visa.
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Emergency Contact Information
Father's name: ________________________________________________________________________________
Home address (if different from yours) (number and street, city or town, ZIP / post code, country)
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Home telephone:____________________________
Business telephone:________________________________
Fax: ____________________________________ E-mail address:______________________________________
Mother's name: _______________________________________________________________________________
Home address (if different from yours) (number and street, city or town, ZIP / post code, country)
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Home telephone: ____________________________ Business telephone:________________________________
Fax: ____________________________________ E-mail address:_______________________________________
My parents are:
Married
Divorced
Separated
Emergency contact information if different from the information above:
Name:____________________________________
Relationship to you:________________________________
Home address (if different from yours) (number and street, city or town, ZIP / post code, country)
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Home telephone:____________________________
Business telephone:________________________________
Fax: ____________________________________ E-mail address:_______________________________________
Academic Information
Name and address of home university (street address, city or town, Zip / post code, country):
_____________________________________________________________________________________________
_____________________________________________________________________________________________
List
courses
you
are
taking
now
at
your
home
university:
_____________________________________________________________________________________________
_____________________________________________________________________________________________
On a separate sheet, list all courses you have taken. Include course title, final grade, or attach a copy of your official
school listing. Also send an Official Transcript from your home institution to Tulane University as soon as possible.
Essay (required)
Write a personal statement that will help us learn more about you as an individual and provide us with information
that is different from courses, grades and other objective data. Use separate sheets of paper to write a one- to twopage essay, answering these questions in detail:
Why do you want to study in the United States?
Why did you choose Tulane University?
What do you wish to study?
What non-academic experiences would you like to have while studying at Tulane (e.g. meet new people,
get to know the American culture, or the "Southern Culture", experience life at an American university…)?
How do you think the experience of study at Tulane will benefit you in the future?
Finally, describe some of your special interests, significant experiences or achievements. Make sure your name is on
each page.
2
Personal Responsibility Statement
If you check any of the boxes below, please explain the circumstances in detail on a separate sheet. If, after you have
submitted this form, new circumstances change your status or would cause you to check any of the boxes below, you
must notify us as soon as possible.
Check here if you have ever left a school voluntarily for an extended period of time.
Check here if you have ever been placed on probation, suspended or expelled from any school.
Check here if you have ever been convicted of a crime.
Signature
My signature below indicates that the information in my application is complete, factually correct, and honestly
presented.
_____________________________________________________________________________________________
Date
Signature
3
Declaration and Certification of Finances
Important Note:
Tulane University will not issue an DS-2019 Certificate Of Eligibility, which is essential to obtain a
United States visa, until all three parts of the Declaration and Certification of Finances (DCF) have been
completed and the information and the Official Certification of Sources and Amounts has been returned
to the Center of International Studies.
Declaration and Certification of Finances
The purpose of this form is to certify that you will have the approximately $11,000 per year necessary to
support yourself during the academic year (this amount changes every year according to price changes). The
information
provided on the Declaration and Certification of Finances form must be true and accurate. The inclusion of false
information is grounds for dismissal in the United States.
Please be aware that a student visa does not permit international students to work off campus in the United States.
1. Student information for DCF
Student name (last / family name, first name, middle name, Jr., etc.):
_____________________________________________________________________________________________
On the line above, please circle the name by which we should file your credentials at Tulane.
Current mailing address (number and street, city or town, ZIP / post code, country):
Permanent home telephone (country code - area code - number): ________________________________________
Current telephone (if different) (country code - area code - number):______________________________________
Fax:______________________________________
E-Mail address: ____________________________________
For how long do you plan on studying at Tulane University (check one)? One semester
One academic year
2. Financial Information
Can you pay for your round-trip travel to the United States?
Yes
No
Please indicate below how much you or your family will be able to contribute to each of the costs of attending
Tulane University for one year. If you will be using a scholarship or financial aid from a government or
organization, please attach a letter from them detailing your scholarship or financial aid.
Estimate of International Student Expenses.
2008-2009 academic year (August - May)
Student/Family contribution
per year
Tuition and Fees
$37,500
Waived
Room
$5,200
$_____
Books and Supplies
$900
$_____
Board
$3,196
$_____
Personal Expenditures
(clothes, laundry, etc.)
TBD
$_____
Medical Insurance
$1,130
$_____
______________________________________
Total
$41,828
_______________________
Total *$10,618
*This figure must indicate the amount of money, in U.S. dollars, that you will have available per year for your use
while in the United States. Consider applicable exchange and currency regulations in your figures.
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3. Official Certification of Sources of Funds and Amounts
This is to certify that I (Bank Official) have read the information furnished by the applicant on this form, that it is a
true and accurate statement, and that the funds are available.
_____________________________________________________________________________________________
Date
Bank official's signature
Name of bank:_________________________________________________________________________________
Address of bank:_______________________________________________________________________________
I (applicant) understand that inclusion of false information above is grounds for dismissal from Tulane University,
and I attest by my signature that it is factually correct and honestly presented.
_____________________________________________________________________________________________
Date
Signature of student
_____________________________________________________________________________________________
Date
Signature of guarantor
Address of guarantor:___________________________________________________________________________
5
Statement of Good Standing / Recommendation (by International Office at Home University)
Student name (last / family name, first fame, middle name, Jr., etc):
_____________________________________________________________________________________________
The student named above, who has attended your institution, is applying for admission to Tulane University. Would
you please provide the information requested below and include this form with the student-application? We are
interested in the non-academic aspects of the student's stay at your institution, as well as the academic. Thank you.
Would you recommend the applicant? Please check the appropriate box:
Yes
With reservation
No
Please provide additional comments, and if the information is available, we would appreciate your comments on the
applicant's behavior and conduct while attending your institution.
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Signature
___________________________________________________________________________________________
Signature
___________________________________________________________________________________________
Date
Print name and title
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