EXHIBIT B
PROCEDURE 09-02-01
University of Pittsburgh
ASSESSMENT OF ENGLISH LANGUAGE PROFICIENCY FOR ADMISSION
Name of Applicant
Academic Center
Department
Please check one of the following to indicate that the applicant has the required English language
proficiency necessary to undertake the proposed course of study.
Assessment
□
Applicant has the required English language proficiency based on the following:
□
TOEFL result of ________.
Date of test: _________
(Minimum result of 80 on the Internet-based test or 550 on
the Paper-based test.)
□
IELTS result of ________.
Date of test: _________
(Minimum result of Band 6.5)
□
□
□
Applicant is a citizen of a country whose official language is English.
Applicant graduated from a regionally accredited institution in the U.S.
Applicant graduated from an institution where the language of instruction is English and
where the official national language of the country in which the institution is located is English.
This assessment has been made in accordance with University Policy 09-02-01, Assessment of
English Language Proficiency for Admission.
Name and Title of person making determination (Please print)
Department/Program
Signature
Submit Original form to:
Retain copies for:
FORM 0131 (0310) Procedure 09-02-01
Office of International Services
Academic Center/Department