Sample Friendship Letter for Affidavit of Support

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          Application for   The University of Utah

      Domestic and
                            Graduate Admissions Office/
                            International Admissions Office

                            Domestic Admissions Phone: (801) 581-7283

   Graduate School          International Admissions Phone: (801) 581-3091
                            Fax (801) 585-7864

         Admission          Web Address:

                            Email Contacts:

                            Physical Address:
                            250 Student Services Building

                            Mailing Address:
                            201 South 1460 East, Room 250S
                            Salt Lake City, Utah USA 84112-9057
    The University of Utah                                                                                                  Graduate Admissions Application

                                                                   UNIVERSITY OF UTAH
                                                         APPLICATION FOR GRADUATE ADMISSION
                                        This information is available in alternative format with prior notification.
                                            Contact the Center for Disability Service at (801) 581-5020 (V/TDD).
                                                  COLLEGE OF LAW APPLICANTS:	Do	not	use	the	Application	for	Admission	to	Graduate	school.
                                                  Request	admission	instructions	and	an	application	from	the	University	of	Utah,	college	of	Law,
                                          332	s	1400	E,	salt	Lake	city,	Utah	84112-0730,	(801)	581-7479	or	e-mail	request	to .

    Admissions Office Deadlines are:                                                                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	
                Fall Semester  .  .  .  .  .  .  .  .  . April 1                                    card	information	on	this	application.		Please do not mail cash.		send	the	applica-
                Spring Semester  .  .  .  .  .  . November 1                                        tion	and	fee	or	credit	card	payment	form	to:	University	of	Utah,	Admissions	office,	
                Summer Session .  .  .  .  .  .  . March 15                                         201	s	1460	E	Rm.	250	s,	salt	Lake	city,	Utah	84112-9057.
     1. Each academic department has its own admissions procedures and                     3.	 If	you	are	a	Permanent	Resident/Immigrant,	you	must	submit	a	copy	of	your	resi-
        deadlines. Applicants are strongly encouraged to review the individual                 dent	alien	card	with	your	admissions	application.
        department’s web site or contact the department directly to deter-
        mine its admission procedures regarding:                                           4. Have one official copy of academic transcript(s) from each college
     	 •	 Does	the	department	prescreen	its	applications?	If	so,	are	there	different	          you have taken courses from (except the U of U) mailed directly
             admission	procedures	to	be	followed?                                              to the University of Utah,	Graduate	Admissions	office,	201	s	1460	E	Rm.	
     	 •	 Does	the	department	have	a	separate	application	to	be	completed?                     250	s,	salt	Lake	city,	Utah	84112-9057.		If you are a “Readmission” applicant,
                                                                                               you must have one official copy of your transcript(s) mailed from only
     	 •	 What	is	the	department’s	deadline	for	submitting	admission	forms?                    the colleges you attended since you last attended the University of Utah .
     	 •	 Does	the	department	require	a	graduate	test	such	as	GRE	or	GMAT?                     Transcripts	submitted	for	admission	become	the	property	of	the	University	and	are	
     	 •	 Does	the	department	require	letters	of	recommendation?                               not	returned.		Failure to list ALL institutions previously attended or degrees
     	 •	 Does	the	department	require	personal	statements,	resumes,	or	a	writing	              pursued or making false or misleading statements on the application may
             sample?                                                                           result in denial of admission, loss of credit and dismissal from the University
    	 •	 Does	the	department	admit	every	term?                                                 of Utah .
    	 Most	departments	require	that	admissions	files	are	completed	(meeting	all	univer- 5.	 If	you	were	previously	enrolled	in	a	graduate	program	that	you	did	not	complete,	
        sity	and	departmental	requirements)	from	three	to	six	months	before	the	semester	      you	must	provide	a	written	statement	explaining	the	reasons	for	non-completion.		
        for	which	admission	is	desired.	 This application is due in the Admissions             This	should	be	submitted	with	your	application	to	the	Admissions	office.
        Office a minimum of THIRTY DAYS before the academic departmental 6. NoN–cITIzENs	of	ThE	UNITED	sTATEs	must	provide	“proof	of	English	proficiency”.		
        deadline for U.S. citizens and SIXTY DAYS before the academic depart-                  The	University	of	Utah	will	accept	the	Test	of	English	as	a	foreign	Language	(ToEfL)	or	
        mental deadline for non-U.S. citizens.                                                 the	International	English	Language	Testing	system	(IELTs)	for	applicants	whose	first	
        NoN-cITIzENs	of	ThE	U.s.–	Many	graduate	departments	require	applicants	to	             language	is	not	English.	No	application	will	be	considered	without	these	test	results.	
        submit	the	Test	of	spoken	English	(TsE).	Applicants	should	contact	their	major	        The	official	ToEfL	score	must	be	sent	directly	to	the	International	Admissions	office	
        department	to	determine	(TsE)	requirements.	To	register	for	this	test	please	          by	Educational	Testing	service	and	must	not	be	over	two	years	old	at	time	of	admis-
        contact:	Test	of	spoken	English,	Po	Box	6151,	Princeton,	New	Jersey	08541-6151	        sion.	The	official	IELTs	score	can	be	requested	from	the	test	centre	where	the	test	was	
        UsA.	                                                                                  administered.	The	minimum	test	score	requirements	can	be	found	on	the	International	
                                                                                               Admissions	website	(	Many	depart-
    2.	 complete	the	University	of	Utah	Application	for	Admission	to	Graduate	school	and	      ments	require	a	higher	English	proficiency	score	than	the	University	of	Utah	minimum	
        pay	the	NONREFUNDABLE	application	fee	based	on	the	following	classifications:          requirement.	Applicants	should	check	with	their	major	department	to	determine	English	
    	 •	 New	student:	If	you	have	not	previously	attended	as	a	degree-seeking	                 proficiency	requirements.
             student	at	the	University	of	Utah,	check	“New	student”	and	include	the	
             NONREFUNDABLE	application	fee.                                               	 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	
    	 •	 If	you	have	been	or	are	currently	a	degree-seeking	(matriculated)	student	            examination.	students	who	have	not	lived	in	the	U.s.	for	two	or	more	years	will	be	
            at	the	University	of	Utah,	check	“Readmission”	and	include	the	NON-                required	to	successfully	complete	the	ToEfL	or	IELTs	exam	before	being	admitted	
            REFUNDABLE	application	fee.                                                        or	readmitted	to	the	University	of	Utah.	Previous	examination	scores	will	not	be	
    	 The	application	fees	are:                                                                used	to	meet	this	requirement.
    	 •	 Domestic	applicants	pay	$55.00.
                                                                                          	 students	who	have	lived	in	the	United	states	for	less	than	five	years,	and	have	
    	 •	 International	applicants	on	a	visa	or	in	need	of	a	visa	pay	$65.00.                   not	met	the	English	requirement	through	coursework	at	another	institution,	will	
    	 •	 A	late	handling	fee	of	$30.00	is	charged	on	applications	received	after	the	          be	required	to	successfully	complete	one	of	the	English	proficiency	exams	before	
            Admissions	office	deadlines.		Note:	Paying	the	late	handling	fee	does	not	         being	considered	for	admission.	The	University	of	Utah	reserves	the	right	to	require	
            guarantee	review	of	your	application	by	the	department	of	your	intended	aca-       English	proficiency	when	deemed	necessary.
            demic	plan	(major).
    	 •	 All	fees	are	NONREFUNDABLE .                                                     7. NoN-cITIzENs	of	ThE	UNITED	sTATEs	may	be	required	to	provide	the	following:
    	 •	 FEE WAIVER REQUESTS ARE NOT GRANTED.                                             	 •	 Financial Statement.		In	order	to	issue	the	I-20	certificate	of	Eligibility	
The University of Utah                                                                                                      Graduate Admissions Application
      students	must:	1)	be	accepted	to	the	University	of	Utah	as	a	matriculated	         8. No action will be taken until your application, transcripts, and appro-
      student,	and	2)	submit	proof	of	financial	responsibility.		(for	amounts	needed,	       priate fees have been received by the Admissions Office.		In	addition,	the	
      see	costs	and	fees	listed	at	our	web	site	at	         department	of	your	intended	academic	plan	(major)	will	take	no	action	until	all	
      financial	statements	become	the	property	of	the	University	of	Utah	and	can-            university	and	departmental	admissions	requirements	have	been	met.
      not	be	returned	to	the	student.		financial	statements	are	valid	for	only	one	      9.	 Applicants	may	apply	to	multiple	departments.	only	one	application	fee	will	
      year.		If	a	student	needs	a	new	I-20	certificate	of	Eligibility	for	any	reason,        be	charged	for	the	first	two	applications	submitted	for	the	same	semester	and	
      and	the	financial	statement	on	file	is	over	a	year	old,	a	new	financial	state-         year.	however,	a	separate	and	complete	application	must	be	submitted	for	each	
      ment	will	be	required.                                                                 department.	You	may	submit	only	one	application	online.	Additional	applications	
 	 	 If	an	applicant	is	awarded	financial	assistance	through	the	academic	depart-            may	be	submitted	by	completing	a	hard	copy	admissions	application	and	mailing	
      ment	and	the	financial	assistance	is	sufficient	to	issue	the	I-20	certificate	of	      or	faxing	it	to	the	Admissions	office	with	the	appropriate	fee(s).	The	application	
      Eligibility,	no	further	financial	information	is	required.                             fee	will	be	charged	for	each	application	submitted	beyond	the	first	and	second	
 	 •	 Sponsor’s Statement. 	students	who	are	financing	their	own	studies	must	               applications.	A	late	application	fee	will	be	charged	for	each	application	received	
      submit	a	bank	statement	or	other	documents	showing	they	have	sufficient	               after	the	Admissions	office	printed	term	deadlines.
      funds	for	their	first	year’s	expenses.		The	bank	statement	or	other	documents	
      must	also	indicate	that	the	account	has	been	in	the	applicant’s	name	for	at	       10. An offer of acceptance is valid only for the semester the applicant is
      least	six	months.		students	who	are	being	sponsored	by	their	family,	other	            admitted.	If	an	applicant	does	not	register	for	classes	during	his/her	admitted	term,		
      individuals	or	agencies	must	have	their	sponsor	submit	a	statement	that	they	          the	applicant	must	resubmit	an	admissions	application	and	fee	before	the	applica-
      (the	sponsor)	will	assume	financial	responsibility	for	the	student’s	first	year	       tion	deadline	for	the	semester	he/she	wishes	to	begin.	once	admitted	and	enrolled,	
      expenses,	including	tuition	and	living	expenses.		In	addition,	the	sponsor	must	       graduate	students	are	required	by	Graduate	school	policy	to	maintain	continuous	
      submit	a	bank	statement	or	other	proof	that	sufficient	funds	are	available	for	
      the	student’s	first	year	of	study.		The	International	Admissions	office	can	sup-       registration	during	the	academic	year	of	fall	and	spring	semesters.	If	a	graduate	
      ply	an	official	Affidavit	of	support	for	the	sponsor	to	complete.		otherwise,	the	     student	must	stop	out,	he/she	should	file	the	appropriate	paperwork	for	an	“official	
      sponsor’s	statement	must	be	notarized	or	submitted	on	an	official	document	            Leave	of	Absence.”	students	failing	to	maintain	continuous	registration	and	who	
      or	letterhead.		If	a	student	is	being	sponsored	by	their	Embassy,	Government,	         have	not	been	granted	an	official	leave	of	absence	must	reapply	for	admission	to	the	
      or	Educational	Agency,	a	letter	of	sponsorship	is	all	that	is	required.                Graduate	school	through	the	Admissions	office	by	submitting	an	admission	applica-
                                                                                             tion	and	fee .
                                                                                            	   *fee	is	subject	to	change	without	notice.

Financial Assistance                                                                            born	after	December	31,	1956,	are	required	to	submit	proof	of	immunity	to	the	
Three	categories	of	financial	assistance	are	available	to	graduate	students.                    student	health	service.		students	must	have	evidence	of	immunity	to	or	appropri-
•	 Department	Assistantship	and	fellowships:	contact	the	department	of	your	                    ate	vaccinations	against	measles,	mumps,	and	rubella.		for	further	information	
   intended	academic	plan	(major).                                                              about	health	services	provided	and	the	PIR	requirement,	please	contact:	University	
•	 specific	fellowships	and	Awards:	contact	the	University	of	Utah,	Graduate	                   of	Utah	Madsen	health	center,	555	foothill	Boulevard,	salt	Lake	city,	Utah	84112,	
   fellowships	office,	201	s	Presidents	circle	Rm.	302,	salt	Lake	city,	Utah	                   Phone	(801)	581-6431.
   84112-9016,	(801)	581-6020.                                                                  Non-citizens of the U.S.
•	 student	Loans:	contact	the	University	of	Utah,	office	of	financial	Aid	and	
                                                                                                •	 The	International	center	is	located	in	Room	410	of	the	olpin	Union	Building.		
   scholarships,	201	s	1460	E	Rm.	105,	salt	Lake	city,	Utah	84112-9055,	(801)	
                                                                                                   The	International	student	services	division	(Room	410)	of	the	center	provides	
                                                                                                   support	services	to	international	students	and	scholars	including	Immigration	
•	 Non	U.s.	citizen	applicants	should	contact	the	academic	department	of	their	
                                                                                                   services,	orientation	for	new	students	and	scholars,	spouse	Activities	and	
   choice	for	information	concerning	financial	assistance.
                                                                                                   friendship	family	Program	and	the	International	student	council.		for	further	
Housing                                                                                            information	about	the	International	center,	please	contact	their	offices	directly	
single	students	desiring	on-campus	graduate	housing	should	contact	the	                            at	(801)	581-8876	or	check	their	web	site	at .
University	of	Utah,	housing	&	Residential	Education,	5	heritage	center,	                        •	 Applicants	may	apply	directly	to	the	University	of	Utah.		It	is	not	necessary	to	
Benchmark	Plaza,	Bldg.	822,	salt	Lake	city,	Utah	84112-2036,	(801)	587-2002.		                     go	through	a	private	agent	or	pay	additional	fees	to	apply.
students	with	families	should	contact	the	University	of	Utah,	student	Apartments,	
1945	sunnyside	Avenue,	salt	Lake	city,	Utah	84108,	(801)	581-8667.                              The	University	of	Utah	General	catalog	is	a	source	of	information	on	Graduate	
                                                                                                school	policy	and	procedures.		The	General	catalog	may	be	viewed	online	at	
Disabled Students                                                                      .
for	information	on	facilities	and	programs	for	disabled	students,	write	University	
                                                                                                online	information	regarding	graduate	studies	at	the	University	of	Utah	is	also	
of	Utah,	center	for	Disability	services,	200	s	central	campus	Drive	Rm.	162,	salt	
                                                                                                available	on	the	Graduate	school’s	web	site, .
Lake	city,	Utah	84112-9107,	or	telephone	(801)	581-5020	(voice	or	TDD).
                                                                                                for	more	information	about	the	University	of	Utah,	we	strongly	urge	you	to	go	
Student Health Service                                                                          online at	so	you	may	acquaint	yourself	with	the	academic	
The	student	health	service	provides	on-campus,	low-cost,	quality	primary	medi-                  programs	offered,	and	the	policies	and	procedures	of	the	University.		Also,	check	
cal	care	to	all	University	students	and	their	dependent	families.		fees	are	                    the	Admissions	office	web	site	at	to	track	the	
charged	for	most	services	and	payment	is	requested	at	the	time	of	service.		                    processing	of	your	application.
PRoof	of	IMMUNITY	REQUIREMENT	(PIR)	–	All	new	and	transfer	students	
                                            PLEASE RETAIN THIS INFORMATION FOR YOUR FUTURE REFERENCE AND USE.                                                                           2
  The University of Utah                                                                                                    Graduate Admissions Application
  LIST OF ACADEMIC MAJORS AND DEGREES OFFERED (Please use this list to answer questions #14 and 15 on the application. Listing the accurate title of
  the academic major is crucial in forwarding this application to the appropriate academic department. If you have questions, please call the Admissions
  Office at (801) 581-7283.)
      Accounting MAC                                           Environmental	humanities	MA,	Ms                               Neuroscience	PhD
      Anthropology	MA,	Ms,	PhD                                 Environmental	science	PsM	(PrMs	science	&	                    Nuclear	Engineering	MEN,	Ms,	PhD
      Architectural	studies	Ms                                 Technology)                                                   Nursing	Ms,	PhD
      Architecture	MAR                                         Exercise	&	sport	science	Ms,	EDD,	PhD                         Nursing	Practice	DNP
      Art	history	MA                                           Experimental	Pathology	PhD                                    Nutrition MS
      Art MFA                                                  family	and	consumer	studies	MED	(Early	childhood	Ed.)         occupational	health	Moh,	Ms
      Asian	studies	MA                                         film	and	Media	Arts	MfA                                       occupational	Therapy	MoT,	DoT
      Atmospheric	sciences	Ms,	PhD                             Finance MS                                                    oncological	sciences	MA,	Ms,	PhD
      Audiology	MA,	Ms,	AUD                                    Genetic	counseling	Ms                                         Parks	Recreation	&	Tourism	Ms,	EDD,	PhD
      Ballet	MA,	MfA                                           Geography	MA,	Ms,	PhD                                         Pharmaceutics	&	Pharmaceutical	chemistry	Ms,	PhD
      Biochemistry	Ms,	PhD                                     Geological	Engineering	MEN,	Ms,	PhD                           Pharmacology	&	Toxicology	Ms,	PhD
      Bioengineering	MEN,	Ms,	PhD                              Geology	Ms,	PhD                                               Pharmacotherapy	Ms,	PhD
      Biological	chemistry	PhD                                 Geophysics	Ms,	PhD                                            Pharmacy	DPh
      Biology	Ms,	PhD                                          Gerontology	Ms                                                Philosophy	MA,	Ms,	PhD
      Biomedical	Informatics	Ms,	PhD                           health	Promotion	&	Education	Ms,	EDD,	PhD                     Physical	Therapy	DPT
      Biostatistics	MsT                                        healthcare	Administration	MhA                                 Physician	Assistant	studies	MPs
      Biotechnology	PsM	(PrMs	science	&	Technology)            history	MA,	Ms,	PhD                                           Physics	MA,	Ms,	PhD
     	Business	Administration	ExMBA,	MBA,	PrMBA,	PhD           human	Development	&	soc	Policy	Ms                             Physiology	PhD
     Business	MsT                                              human	Genetics	Ms,	PhD                                        Political	science	MA,	Ms,	PhD
     chemical	Engineering	MEN,	Ms,	PhD                         Information	systems	Ms                                        Psychology	MA,	Ms,	MsT,	PhD
     chemical	Physics	PhD                                      International	Affairs	&	Global	Enterprise	Ms                  Public	Administration	ExMPA,	MPA
     chemistry	MA,	Ms,	PhD                                     Laboratory	Medicine	and	Biomedical	science,	Ms                Public	health	MPh,	Ms,	PhD
     city	&	Metro	Planning	McP                                 Language	Pedagogy	MA                                          Public	Policy	MPP
     civil	&	Envir	Engg	Ms,	PhD                                Languages	&	Literature	MA,	PhD                                Real	Estate	Development	MRD
     clinical	Investigation	Ms                                 Linguistics	MA,	PhD                                           Rehabilitation	science	PhD
     communication	MA,	Ms,	PhD                                 Material	science	&	Engineering	MEN,	Ms,	PhD                   science	Instrumentation	PsM	(PrMs	science	&	
     computational	science	PsM	(PrMs	science	&	                Mathematics	MA,	Ms,	MsT,	PhD                                  Technology)
     Technology)                                               Mechanical	Engineering	MEN,	Ms,	PhD                           science	Program	Ms	(for	secondary	school	teachers)
     computational	Engineering	&	science	Ms                    Medicinal	chemistry	Ms,	PhD                                   social	Work	MsW,	PhD
     computer	science	MEN,	Ms,	PhD                             Medicine	MD                                                   sociology	MA,	Ms,	MsT,	PhD
     computing	Ms,	PhD                                         Metropolitan	Plan,	Policy	and	Design	PhD                      special	Education	MED,	Ms,	PhD
     creative	Writing	MfA                                      Metallurgical	Engineering	MEN,	Ms,	PhD                        speech-Language	Pathology	&	Audiology	PhD
     Econometrics	MsT                                          Middle	East	studies		MA,	PhD                                  speech-Language	Pathology	MA,	Ms
     Economics	MA,	Ms,	PhD                                     Mining	Engineering	MEN,	Ms,	PhD                               statistics	MsT
     Education,	culture	&	society	MA,	MED,	Ms,	PhD             Modern	Dance	MA,	MfA                                          World	Languages	MA
     Educational	Leadership	&	Policy	MED,	EDD,	PhD             Molecular	Biology	PhD
     Educational	Psychology	MA,	MED,	Ms,	MsT,	PhD              Music	MMU,	PhD
     Electrical	&	computer	Engineering	EE,	MEN,	Ms,	PhD        Musical	Arts	DMA
     English	MA,	PhD                                           Musicology	MA
     Environmental	Engineering	MEN,	Ms,	PhD                    Neurobiology	and	Anatomy	Ms,	PhD

                                                                             Credit Card Payment Form
                                               charge	my	credit	card	for	the	admission	application	fee	and	(if	applicable)	late-handling	fee:
  student	Name: _________________________________________ 	                                        cardholder	Name: ______________________________________
  student	soc.	sec.	No.: _____________________________________ 	                                   card	Number: _________________________________________
  Phone	Number: _________________________________________ 	                                        Expiration	Date: ________________________________________
  card	Type:			 	Discover					 	Mastercard					 	VIsA					 	AMEX	                        	         Amount	$ ___________________________________________
  cardholder	Billing	Address: ________________________________________________________________________	 zip	code:	 __________

3 cardholder	signature _____________________________________________________________________________________________
The University of Utah                                                                                                                                                                                     Graduate Admissions Application
                                                                                                                                                                                                                                            Application Deadline
ADMISSION APPLICATION                                                                                                                                                                                                                      Fall       Spring        Summer
This	application	is	due	in	the	Graduate	Admissions	office	a	minimum	of	THIRTY DAYS	before	the                                                                                                                                             Apr 1       Nov 1          Mar 15
                                                                                                                                                                                                                                (Additional $30.00 late fee after the deadline)
Academic	Departmental	deadline	for	U.s.	citizens	and	SIXTY DAYS	before	the	Academic
Departmental	deadline	for	Non	U.s.	citizens.	carefully	read	the	application	instructions
before	filling	out	this	form.	complete	and	return	the	application	with	the	proper	NONREFUNDABLE FEE
to:	University	of	Utah,	Graduate	Admissions	office,	201	s	1460	E	Rm.	250	s,	salt	Lake	city,	Utah	84112-9057.
 SEMESTER APPLYING FOR (Circle ONE Only) (Select the semester you plan to start/enroll in your graduate program):
 			fall	semester	(Aug)									spring	semester	(Jan)									summer	session	(May)									Year	applying	for	________	
 CHECK ALL THAT APPLY BELOW, FEE WAIVER REQUESTS ARE NOT GRANTED:                                                                                                                                                                              For Office Use Only
 ___	 New	student	                                                                                                                                                                                               ID _____________________________
 ___	 Readmission:	List	UofU	student	ID# _________________________________________
 	        Previous	dates	of	attendance:	from	____________________	to	___________________                                                                                                                         APPL	#___________________________
 	                                                                                                 Term/Year	                                                        Term/Year
 ___	 Domestic	Application	fee	is	$55.00	(NON-REFUNDABLE)                                                                                                                                                        Residency	____	Residency	Location _________
 ___	 International	Application	fee	is	$65.00	(NON-REFUNDABLE) (Applicants	on	a	visa	or	in	need	of	a	visa)
 ___	 Late	fee	for	applications	received	after	the	Admissions	office	deadline	is	$30.00	(NON-REFUNDABLE)                                                                                                         Unclear	Res	Ltr	sent	_________	by	 ________
The	 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	84112-9004,	(801)	581-8365	(voice/TDD),	or	online	at

PERSONAL INFORMATION (Please type or print clearly and answer all questions.)
                                                                                                                                                        Non-citizens of the United States, please provide the following information.
 1. Full legal name _________________________________                                                                                                  6. Are	you	currently	residing	in	the	United	states?		Yes	____	No____
                                           ____________________________________________                                                                7. What is your VISA status? check	one	of	the	following:
 	                                         first/Given                                                                                                        F-1         F-2
                                           ____________________________________________                                                                       J-1						 J-2
 	                                         Middle                                                                                                             Permanent	Resident/Immigrant.
 	       other	names	under	which	your	academic	records	may	be	listed:                                                                                         List	Alien	Registration	Number:		A__________________.	
          __________________________________________                                                                                                          Date	Issued	___________________				
                                                                                                                                                                   (ATTACH A COPY OF YOUR PERMANENT/RESIDENT ALIEN CARD)
 2.	     U.	s.	social	security	Number	*                                                                                                                            have	applied	for	Permanent	Resident	status	or	Political	Asylum	with	UscIs.
 3.	     Date	of	Birth	(Month/Day/Year)	                                                                                                                           Date	of	application	______________
 4.	     country	of	Birth _________________________________                                                                                                        Refugee	
                                                                                                                                                                   other	(please	explain):	 ________________________________
 5.	     country	of	citizenship _________________________________                                                                                                  Utah	high	school	Graduate	Requesting	Utah	hB	144	(2002)	consideration
 8.	     Gender:							_____Male ____Female
 9.	     Ethnic	origin:	choose	the	one	that	best	describes	you	(optional)
 	       a.	 Do	you	consider	yourself	to	be	Latina/o	or	hispanic?				 Yes          No
 	       b.	In	addition,	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
 	       c.		Please	select	one	or	more	of	the	following	ethnic	categories	to	describe	yourself:
             Latina/o or Hispanic:       Central American        Cuban American         filipina/o			 Mexican	American	or	chicana/o			 Puerto	Rican			 South American
                                         Spanish        other	Latina/o	or	hispanic
             American Indian or Alaska Native:           cherokee			 crow			 Dine’	(Navajo)			 Goshute			 hopi			 Paiute			 Shoshoni                   Ute
                                                         other	American	Indian	or	Alaska	Native
             Asian American:        cambodian	American			 Chinese American               Japanese	American			 Korean American          Laos	American			 Thai	American
                                    Vietnamese American          Other Asian American
             Pacific Islander:      Native	hawaiian			 Polynesian			 Samoan               Tongan			 other	Pacific	Islander
 10.	Are	you	a	veteran	of	the	United	states	Armed	forces?		____	Yes					____	No
 11.	Mailing	Address	                                 	                                                                                                             Permanent/home	country	Address
       ______________________________________________                                                                                                              __________________________________________________
       ______________________________________________                                                                                                              _____________________________________________
       ______________________________________________                                                                                                              __________________________________________________
 	       	    city	                                                               state/Province	                                                                    city	                                                              state/Province
             ______________________________________________                                                                                                        _____________________________________________
 	       	    country	                                                          zip	or	Postal	code	                                                                  country	                                                         zip	or	Postal	code

	*Privacy	Act	Notice:	The	University	confidentially	maintains	all	application	information,	including	your	social	security	Number	for	routine	uses	such	as	facilitating	document	matching,	verifying	your	identity,	and	expediting	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.
                                                                                                                                                                                                                                                                Continued on next page                               4
    The University of Utah                                                                                                                     Graduate Admissions Application
    Personal Information continued

     12. Telephone:	U.s.	home:	(									)	______________________________	U.s.	cell:	(									) _______________________________________
     13. E-mail	address: _______________________________________________________________________________________
     14.		What	graduate	program	are	you	applying	to:	(select	from	the	“List	of	Academic	Majors”	on	page	three	of	the	instructions.	If	your	program	was	not	found	on	this	list,	please	
         call	the	Admissions	office	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.	What	is	your	first	language?__________________________	List	other	languages	you	write	and	speak _______________________________
     17.	Undergraduate	major(s) __________________________________________________________________________________
     18. 	Person	to	notify	in	case	of	emergency:
          Name _______________________________________ 	 Relationship	________________			Telephone	(________)	_____________
     	                                                                                                                                                                   Area	code
     	   Address ____________________________________________________________________________________________
     	                 Number	and	street		                                    city	                                            state	or	country	                                     zip	code

    (All applicants must complete questions 19 through 23 on all applications submitted for admission or readmission. Failure to complete these questions will result in
    classification as a NON-RESIDENT FOR TUITION PURPOSES. )

     19.	Your	U.s.	state	of	legal	residence	_____________________		from	(Month/Day/Year)	___________________	to	(Month/Day/Year)	 ___________
     20.	how	long	have	you	lived	in	Utah?		______________				continuously	since	(Month/day/year) _________________________________________
     21.	Do	you	have	a	driver’s	license?	____Yes				____No					Issuing	state	__________		Date	of	Issue	(Month/year)	 _______________________________
     22.	Indicate	what	you	have	been	doing	(e.g.	employment,	volunteer,	work	from	home,	training,	school,	military)	and	where	you	have	been	for	the	past	three	years.		Be	specific
         and	account	for	all	months.					(If	additional	space	is	required,	please	attach	a	separate	sheet	of	paper.)
         From Month/Day/Yr                    To Month/Day/Yr                 Activity                                              City and State
         ___________________                    ________________                      ____________________________________                                 ____________________________
         ___________________                    ________________                      ____________________________________                                 ____________________________
         ___________________                    ________________                      ____________________________________                                 ____________________________
         ___________________                    ________________                      ____________________________________                                 ____________________________
         ___________________                    ________________                      ____________________________________                                 ____________________________
     23. Parents (please list even if deceased)
     	 father’s	name _______________________________________	                                                   Mother’s	name ______________________________________
     	 Address ___________________________________________	                                                     Address __________________________________________
         ________________________________________________                                                        ______________________________________________
     	 father’s	state	of	legal	residence: _____________________________	                                        Mother’s	state	of	legal	residence:____________________________
     	 how	long?	______________ ___________________________	                                                    how	long?	 ________________________________________

     Only U.S. citizens complete Question 24
     24. 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 Graduate Admissions Office.		Transcript(s)	must	be	received	before	any	action	can	be	taken.		Please	note	if	you	are	filing	as	a	“Readmission”	applicant,	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.
                                                                                                                                                       Degree Earned            Self
         Name of Institution                                                                                   Dates of Attendance                     and Date                 Reported
         (DO NOT Abbreviate)                                Location                                  From (Mo./Year) To (Mo./Year)                    Received/Expected Grade Point
         ___________________________                           _______________________                         ____________                ____________              _____________               _________
         ___________________________                           _______________________                         ____________                ____________              _____________               _________
         ___________________________                           _______________________                         ____________                ____________              _____________               _________
         ___________________________                           _______________________                         ____________                ____________              _____________               _________
         ___________________________                           _______________________                         ____________                ____________              _____________               _________
         ___________________________                           _______________________                         ____________                ____________              _____________               _________
                 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.                              Continued on next page
The University of Utah                                                                                                                     Graduate Admissions Application
Educational History continued

 Only Non-citizens of the U.S. complete Question 25
25.	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	
    additional	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	
    International	Admissions	office.		Transcript(s)	must	be	received	before	any	action	can	be	taken.
    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.

26.	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)? _______________________________________________
27.	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).
28.	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 Name                       Date of Birth                 Country of Birth             Country of                Relationship to Student Gender
     __________________ ________________ ______________ ______________ ____________ __________________ ________
     __________________ ________________ ______________ ______________ ____________ __________________ ________
     __________________ ________________ ______________ ______________ ____________ __________________ ________
     __________________ ________________ ______________ ______________ ____________ __________________ ________
     __________________ ________________ ______________ ______________ ____________ __________________ ________
     __________________ ________________ ______________ ______________ ____________ __________________ ________
     __________________ ________________ ______________ ______________ ____________ __________________ ________
                    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 USA 84112-9113.            Continued on next page                                            6
    The University of Utah                                                                                                        Graduate Admissions Application

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

     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	•	Major	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	•	

     The	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,	salt	Lake	city,	UT	84112-9107,	(801)	581-5020	(voice/TDD),	or	online	at	disability/

     University of Utah, and will not be released to students or forwarded to other institutions or agencies.
     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 ____________________________

      •	 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	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.
      •	 University	Admissions	office	Application	Deadline:	fall	semester	(Apr	1)				spring	semester	(Nov	1)				summer	session	(Mar	15)
      •	 send	the	graduate	admissions	application,	fee,	and	transcripts	to:	UNIVERsITY	of	UTAh,	GRADUATE	ADMIssIoNs	offIcE,	201	s	1460	E	RooM	250s,	sALT	LAKE	cITY	UT	
      •	 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 Graduate
         Admissions Office .
      •	 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	Admissions	office.
      •	 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	Admissions	or	to	track	your	application	go	to:

7     Rev 10/10

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