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International Student Services - Application for Admission

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I wish to begin in (year)

Please select one of the following programs. (Either ESL at ACCESS or Academic)

ESL at ACCESS:

Academic:

I am seeking admission to

ESL at ACCESS Program:

ESL at ACCESS

Select one of the options below if you are pursuing programs in addition to Ashland's ESL program

Additional Programs:

Undergraduate Degree, Freshman or Non-Degree

Undergraduate Degree, Transfer or 2nd Degree

Graduate Short-term Study

Master of Business Administration

Master of Education

If you selected Undergraduate Degree above, please write in the box, the degree program you are pursuing.

Undergraduate Degree:

Name (as it appears on your passport)

Given/First Name: *

Middle Name (if any):

Family/Last Name: *

Residential Address

This address is in the country of citizenship, required for immigration information, please no PO Boxes.

Address: *

Apt:

City: *

State/Province:

Country: *

Zip:

Mailing Address

This address is where the acceptance package should be mailed. Please fill out the following, if different from your residential address.

Is your Mailing Address the same as your Residential Address?: *

Address:

Apt:

City:

State/Province:

Country:

Zip:

Contact Information

Phone Number: *

This is the phone number at your mailing address. It is required for express mail delivery.

Personal Phone Number:

Please fill this out if your phone number is different than number above.

Email Address: *

This is the applicant's email address, not the advisor's.

Retype Email: *

Personal Information

Gender: *

Male

Female

Marital Status: *

Single

Married

Date of Birth: *

Age: *

Country of Birth: *

Citizenship: *

Additional Information:

Please describe any physical or learning challenges

Visa Status

Please fill out the following if you are currently in the United States

Type of Visa: *

Location of Visa: *

Write the assigned location of your visa. If you selected 'Other' above, please also provide the type of visa.

Education

Please list all institutions attended, starting with high school

School 1

Name of School:

City/Country:

Begin Date:

End Date:

Major:

Degree Expected or Earned:

School 2

Name of School:

City/Country:

Begin Date:

End Date:

Major:

Degree Expected or Earned:

School 3

Name of School:

City/Country:

Begin Date:

End Date:

Major:

Degree Expected or Earned:

School 4

Name of School:

City/Country:

Begin Date:

End Date:

Major:

Degree Expected or Earned:

Standardized Test Scores

List any tests taken, or planning to be taken.

TOEFL

Ashland University Code: 1021

Date Taken:

Score:

IELTS

Ashland University Code: None Required

Date Taken:

Score:

SAT and ACT

The SAT and ACT are not required, however they can increase the amount of undergraduate scholarship award.

SAT

Ashland University code: 1021

Date SAT Taken:

SAT Score:

ACT

Ashland University code: 3234

Date ACT Taken:

ACT Score:

GMAT and GRE

The GMAT and GRE are not mandatory, but if taken will assist with your application to our graduate programs.

GMAT

Ashland University code: 14N-HF-22

Date GMAT Taken:

GMAT Score:

GRE

Ashland University code: 1021

Date GRE Taken:

GRE Score:

Inquiry Data

How did you First Learn About Ashland University?:

Advising Agency (Please complete information below)

Ashland University Representative

Friend

Current Student or Graduate of Ashland University

Internet (any website including www.ashland.edu)

Publication

Name of Student that Referred You:

Advisor's Information

If you used and Advising Agency, please fill in the following information.

Name of Advisor's Agency:

Advisor's Name:

Advisor's Email:

Family Information

Please list any dependents who will be accompanying you.

First Dependent

Family/Last Name:

First Name:

Date of Birth:

Sex:

Country of Birth:

Citizenship:

Second Dependent

Family/Last Name:

First Name:

Date of Birth:

Sex:

Country of Birth:

Citizenship:

Third Dependent

Family/Last Name:

First Name:

Date of Birth:

Sex:

Country of Birth:

Citizenship:

Housing

Housing Selection: *

I intend to apply for university housing

I intend to look for off-campus housing

All full-time undergraduate students who do not live at their primary, permanent resident with immediate relatives are required to live in university housing and participate in the university’s food plan (known as board), unless the student is 22 or over prior to September 1 of the academic year. Occasionally, exceptions to this policy are granted by making application to the Office of Residence Life. Any student who lives off campus without authorization my be invoiced for full room and board charges.

Graduate students (or students age 22 or over) are not required to live on campus. If you choose to live off campus, you will be placed in temporary housing upon arrival and given information to locate your own housing in Ashland. Affordable apartments and rooms in homes (shared kitchen and bath) are available within walking distance.

Accident & Sickness Insurance: *

I understand that health insurance is mandatory

All international students in F-1 and J-1 visa status enrolled at Ashland University are required to purchase the accident and sickness insurance plan sponsored by the university, unless coverage from your home country is equal to or exceeds the Ashland University coverage.

Certification: *

I Agree

By submitting this application, I hereby certify that information stated is accurate and complete. I understand that any misrepresentation of facts on this application could be cause for suspension from the University. Additionally, I agree to adhere to the conduct norms of the campus community and all policies/regulations of Ashland University.

Tel: 419-289-5068

Fax: 419-289-5629

Toll-Free (U.S. & CAN):
1-800-882-1548, ext. 5068

All times are Eastern Standard Time (EST).
Monday – Friday	8am to 12pm 1pm to 5pm
Summer Hours
Mon - Friday	By appointment 9am to 12pm
Mon - Friday	Walk-in 1pm to 3:30pm

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