ONLINE INTERNATIONAL STUDENT APPLICATION FORM
 
 

Items required to complete the International Admissions Process:

  • International Student Application Form (completed and signed)
  • $25.00 Application Fee
  • Official High School Transcript both in English and in the original language or GED (or High School Graduate Equivalency Test Scores)
  • In case of a college transfer student, college or university transcripts you have attended in English
    and in the original language and Official School Transfer Form required by the INS
  • TOEFL Score or other certified English language proficiency (preferred)
  • Confidential Financial Statement showing the proof of financial support sufficient to cover tuition,
    living expenses and others
  • Confirmation of Immigration Status
 
 
RED indicates a required field.
PERSONAL INFORMATION
Family Name:
Given / First Name:
Middle Name:
2nd Middle Name:
Home Phone Number (country code - area code - phone number):
E-Mail Address:
Social Security No. (if applicable):
Birth Date (month /day /year):
/ /
Sex:
Birth Place (City, State, Country):
, ,
Are you a US Citizen?:
Country of Citizenship (if not U.S. citizen):
Passport Identity Number:
Resident Alien Number:
Marital Status:
Ethnic Origin:
PERMANENT ADDRESS INFORMATION
Permanent Address:
City:
State /Province /Preficture:
Zip or Postal Code:
Country:
MAILING ADDRESS INFORMATION Same as Permanent Address
Mailing Address:
City:
State /Province /Preficture:
Zip or Postal Code:
Country:
ENROLLMENT INFORMATION
NOTE: Choose Special Student Status only if you are a non-degree seeking student!
TOEFL Test Score:
Other English Proficiency Test Score:
Name of the Test:
ACT Composite or SAT Combined Score:
I am enrolling for the (month/year): /
I am applying for: status.
Have you ever applied to S-TU or SIU?:
If Yes, when?:
Intended Major:
BILLING INFORMATION Same as Permanent Address
Billing Address:
City:
State /Province /Preficture:
Zip or Postal Code:
Country:
PARENT/GUARDIAN'S INFORMATION
Relation to Next Of Kin:
Your Parents are:
FATHER'S OCCUPATION INFORMATION
Position:
Father's Name (First and Last):
Employer:
MOTHER'S OCCUPATION INFORMATION Position:
Mother's Name (First and Last): Employer:
GUARDIAN'S OCCUPATION INFORMATION Position:
Guardian's Name (First and Last): Employer:
EDUCATION INFORMATION
Secondary Schools
List all secondary schools or high schools, beginning with the most recent, and include date(s) of graduation and anticipated date of graduation.
1.
School Name:
City:
State/Province/Preficture:
Country:
 
School E-mail Address:
Graduation Date:
  School Phone Number (country code - area code - phone number):
- -
  School Fax Number (country code - area code - fax number):
- -
2.
School Name:
City:
State/Province/Preficture:
Country:
 
School E-mail Address:
Graduation Date:
  School Phone Number (country code - area code - phone number):
- -
  School Fax Number (country code - area code - fax number):
- -
3.
School Name:
City:
State/Province/Preficture:
Country:
 
School E-mail Address:
Graduation Date:
  School Phone Number (country code - area code - phone number):
- -
  School Fax Number (country code - area code - fax number):
- -
Colleges and Universities
List all colleges and/or universities attended, beginning with the most recent.
1. University Name: City:
State/Province/Preficture:
Country:
  University E-mail Address:
Graduation Date:
  Univ. Phone Number (country code - area code - phone number):
- -
  University Fax Number (country code - area code - fax number):
- -
2. University Name: City:
State/Province/Preficture:
Country:
 
University E-mail Address:
Graduation Date:
  Univ. Phone Number (country code - area code - phone number):
- -
  University Fax Number (country code - area code - fax number):
- -
3. University Name: City:
State/Province/Preficture:
Country:
 
University E-mail Address:
Graduation Date:
  Univ. Phone Number (country code - area code - phone number):
- -
  University Fax Number (country code - area code - fax number):
- -
References
Please list two references.
1. Name (first, last): Position:
E-mail Address:
  Phone (country code - area code - phone number):
- -
2. Name (first, last): Position:
E-mail Address:
  Phone (country code - area code - phone number):
- -
OTHER INFORMATION
List Academic Honors Earned (Honor Societies, etc.):

Indicate activities, offices held in high school and years of participation (Sports, Student Government, Publications, Music, Theater, Civic Groups, etc.)

Notice to Prospective Students

Notice of Availability of Campus Security Reports

As provided by the Jeane Clery Disclosure of Campus Security Policy and Campus Crime Statistics Act of 1998, prospective students are entitled to request and receive a copy of the Security Report of any campus of the University they are interested in attending. Each Security Report includes statistics for the past three years concerning crimes and incidents (whether they occurred on campus, in off-campus buildings or property owned or controlled by the University, or on public property adjacent to campus) reported to campus security authorities. Each report also provides campus policies and practices concerning security, how to report sexual assault and other crimes, crime prevention efforts, policies/laws governing alcohol and drugs, victims' assistance programs, student discipline, campus resources, and other matters.

Security Reports for the University are available online through the following University wide link: http://www.salemiu.edu/campus_life/safety/index.shtml

If you do not have access to the Internet, you may obtain a copy of the Security Report for the campus by submitting a request in writing directly to: Jerry Schearer, Clery Act Compliance Officer, Campus Box U, PO Box 500, Salem, WV 26426.
APPLICATION AGREEMENT

I certify this information is true and complete to the best of my knowledge. Falsification of information on this application could jeopardize acceptance and enrollment. I authorize any school or college I have previously attended to release personal and academic information to Salem International University. Further, I agree that my college grades be used for statistical studies or sent to my high school or junior college for evaluation purposes. I understand that official high school (or college) transcript must be sent to the Office of International Admissions before an admission decision can be made.
Check the box if you agree with the statement above:
Today's Date: / /
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