Application Form
UNI Culture & Intensive English Program
General Student Information
Full name (as it appears on your passport):
(Family Name)
(First Name/ Given Name)
Date of Birth:
Gender:
(Middle Name)
___Male
___Female
Email Address:
Native Language:
Country of Citizenship:
City of Birth:
Country of Birth:
This application for admission is for the CIEP 8-week session beginning in:
___Fall 1 (August)
___Spring 1 (January)
___Summer-June
___Fall 2 (October)
___Spring 2 (March)
Year:
Permanent Address (Home Country):
City:
State/Province:
Country:
Postal Code:
Phone Number:
Address for Admission Materials:
City:
State/Province:
Postal Code:
Country:
Phone Number:
Are you currently employed? If yes, please list your profession/job title.
___No
Marital Status:
___Single
___Married
___Yes, _______________________
___Other
How did you learn about CIEP?
Where do you plan to live at UNI? ___Residence Halls/Campus Housing
___Off-campus
Before applying to CIEP, which websites did you visit to learn more about CIEP?
___CIEP Website (www.uni.edu/ciep)
___CIEP Facebook
___CIEP Twitter
___CEA Website
___CIEP YouTube
___Educamia
___Education USA
___UCIEP website
___Agent website
__SSchoolinks
___Undecided
*Check all that apply.
___Study in the USA
___OH! Study
___Target Student Media
___LinkedIn
___None of these.
___Other, Please explain. ___________________________________________________________________________
________________________________________________________________________________________________
Education Information
High School Name:
How many years did you study in secondary school?
Graduation Date:
College or University Name:
How many years did you study at your university or college?
Graduation Date:
Are you literate in another language other than English?
___Yes, I am literate in writing and speaking a language other than English.
___No, I am not literate in writing and speaking a language other than English.
Have you taken the TOEFL?
___No
___Yes
If yes, what is your score?
Passport & Visa Information
Passport Number:
Passport Expiration Date:
Country that issued passport
Are you currently in the United States? ___Yes ___No
If yes, which visa type did you use to enter the country?
Will any of your family be accompanying you to Cedar Falls?
___Yes ___No
If your family is accompanying you to Cedar Falls, please list them below. Please list the name, date of birth, place of birth,
and relationship to you for each family member and submit a copy of his or her passport to your application. If more than
one member is accompanying you, please attach an additional page with the information.
Name:
Place of birth:
Relationship to you:
Date of birth:
Financial Information
Please list the amount of money (in US dollars) that you will have available for your studies. $
How will you fund your studies? (Check all that apply).
___Personal Funds
___Family
___Scholarship
___Other, please explain:___________________________________________________________________________
If you will be funded by a relative or scholarship, please list the contact information below:
Name:
Relationship to you:
Address:
Email Address:
Phone:
Signature of sponsor:
Application Agreement
I confirm that the above information is complete and accurate. I understand that the University of Northern Iowa cannot provide
me with financial aid.
Signature of the student:
Date:
Send application, copy of your passport, financial documentation and $275 non-refundable application fee (make checks
payable to: University of Northern Iowa) to: CIEP -University of Northern Iowa, 1200 W 23rd St., Bartlett 3025, Cedar
Falls, Iowa USA 50614-0511. If you have questions, please contact: ciepadmissions@uni.edu.