Degree Date Awarded/Expected Division, Classification, Rank, Average or percentage of marks received
OBJECTIVE TESTS TAKEN (indicate date each test was taken or plans to take):
Date:............
TOEFL SAT GRE CEEBOther
Notes: This form is distributed by the Institute of Education, New York, to assist American colleges and universities and the foreign students who seek to apply for admission thereto. Its use does not imply sponsorship of applicant by the IIE.
Languages spoken Years of instruction through
at home the medium of English (give dates) .
Years of formal study of
the English language (give dates)
Where? When?
Financial Support
Indicate amount of funds in U.S. dollars available each year for your
education in the U.S.A. and their source

AMOUNT PURPOSE SOURCE

Travel
Maintenance
Tuition & Fees
Will you be requesting financial aid from the University?
...Yes No
Educational Plan
I wish to apply for admission as a candidate for a degree ,
In.............
(A.B., B.S., M.A., Ph.D., etc) (Major Field)
for the term beginning In at (Month and Year) (Name of College of University)

Date:
.Signature:
Indicate proposed plan of study in the U.S.
COMMENTS: (Use this space to explain any item above not fully self­
explanatory; attach second page, if necessary)

Applicant Not to Write Below

Director of Admissions
Reviewed by .Date. Approved for Application
Not approved for Application Comments.