APPLICATION FOR ADMISSION
English as a Second Language Program
and/or
Undergraduate Study
For International Applicants Only
Please print or type
Leave shaded areas blank
__________ Total Fees Received
__________ Recipient Initials
__________ Receipt Date
Application for: Year 20_____
Please check  the boxes. The application fees listed are required and non-refundable.
 Undergraduate Program ($100 application fee)  August  January
 ESL Program ($100 application fee)  August  October  January  March  June
 ESL and Undergraduate Programs ($150 application fee)  August  October  January  March  June
BIOGRAPHIC INFORMATION: Please respond to every question. Incomplete applications will be delayed.
LEGAL NAME (AS IT APPEARS IN YOUR PASSPORT, PLEASE CIRCLE YOUR FAMILY NAME)
BIRTHDATE (month/day/year)
MAILING ADDRESS
CITY
PROVINCE
GENDER  Female  Male
POSTAL CODE
E-MAIL ADDRESS (REQUIRED)
COUNTRY OF BIRTH
COUNTRY
TELEPHONE NUMBER
COUNTRY OF CITIZENSHIP
ACADEMIC BACKGROUND & STUDY PLANS
ALL APPLICANTS
Month and year of high school graduation:
High school name, city, and country:
UNDERGRADUATE APPLICANTS ONLY
What is your intended major?
TOEFL or IELTS score:
ESL PROGRAM APPLICANTS ONLY
 one 8-week session
 three 8-week sessions
What is your expected length of study?
 two 8-week sessions
 four 8-week sessions
REQUIRED ACADEMIC CREDENTIALS

“ESL Program” applicants must furnish a certified and translated copy of their high school diploma/leaving certificate.

“Undergraduate Program” and “ESL and Undergraduate Programs” applicants must furnish certified and translated copies of their high school transcripts
(grade sheets) and their high school diplomas/leaving certificates.

“Undergraduate Program” applicants must arrange for delivery of official TOEFL or IELTS scores. UWSP’s ETS/TOEFL School Code for TEOFL score
delivery is 1919.
REQUIRED FINANCIAL CERTIFICATIONS

“ESL Program” applicants must complete the Financial Support Statement for UWSP English as a Second Language Program Students (page 2 of this
document) and submit supporting bank/sponsor documents as indicated on page 2.

“Undergraduate Program” and “Undergraduate and ESL Programs” applicants must complete the Financial Support Statement for UWSP Undergraduate
International Students (page of this document 3) and submit supporting bank/sponsor documents as indicated on page 3.
I certify that the information supplied by me in this application is correct and complete. I authorize the university to release information
regarding my studies to my parent(s), sponsor(s) and my education agent (if applicable). I understand that the application and courier
fees are required and non-refundable.
____________________________________________
_____________
_____________________________________________
_____________
Applicant Signature
Date
Signature of parent or sponsor if applicant is under 21 years of age
Date
Please send application form, academic credentials, financial documentation, and application fees to:
UW-Stevens Point International Admissions
c/o Brad Van Den Elzen
1801 Fourth Avenue, CCC 108
Stevens Point, WI 54481-1907
USA
Telephone: +1 (715) 346-3849
Do you have questions about completing this application? If so, please contact UWSP International Admissions: isso@uwsp.edu
April 2016
Financial Support Statement for UWSP English as a Second Language Program Applicants
Estimated expenses for two sessions (16 weeks) of study during the 2016-2017 academic year at the University of WisconsinStevens Point are as follows (in USD):
Tuition and Fees
Campus Housing
Campus Meal Service
Insurance & Textbooks
Total
5500.00
2130.00
1626.00
1115.00
$10,371.00
Please note: personal expenses are not included in this estimate
PLEASE NOTE: This is a relatively conservative budget for a student
who spends wisely and is willing to share on campus living quarters
with another student. While some students may need less money,
many students find that they spend more than this amount. This
estimate does not include daily spending money, the cost of
international travel, or keeping an automobile. Expenses may vary
from estimates.
All rates may change at any time.
APPLICANTS ARE REQUIRED TO PROVIDE EVIDENCE OF FUNDS TO SUPPORT A MINIMUM OF TWO SESSIONS (16 WEEKS) OF STUDY.
The minimum enrollment period is one 8-week session. Full payment for the first session of study & related charges is due upon arrival.
Name of Applicant:
Session you plan to enter
Family Name
Year 20_____
_____ Spring I (January)
Given Name
Middle Name (if applicable)
_____ Fall I (September)
_____ Spring II (March)
_____ Fall II (October)
_____ Summer (June)
Choose ONE:
_____ I will be self-supporting. (Please
submit original bank statement* showing
available funds of at least $10,371)
_____ I will be sponsored by one or
more individuals. (Please have sponsor(s)
_____ I will be government-sponsored.
(Please submit official documentation verifying
government support)
complete form(s) and submit bank statements*
totaling at least $10,371)
*An original bank statement is one on bank letterhead, with an official seal. We will accept faxed documents only if faxed directly from your bank or sponsor’s
bank. Your application for admission will not be considered unless both statements below are completed and supported by the requested official documentation.
*******************************************************************************************************************************
SPONSOR’S STATEMENT
I, __________________________________, certify that I have read and understand the above financial support statement. I
further certify that I have the financial resources to cover the expenses of the student, __________________________________,
in the amount of $ __________ per year in addition for travel expenses for a round trip from the student’s home to the
University of Wisconsin-Stevens Point for each calendar year while this individual is in the United States. An original bank
statement on bank letterhead reflecting a balance of at least this amount in U.S. currency is attached. I understand that the
inclusion of any false information concerning financial support will be considered grounds for the student’s dismissal from the
University of Wisconsin-Stevens Point.
Sponsor’s Printed Name
__________________________
Sponsor’s Signature
__________________________
Date
__________________________
Relationship to Student
__________________________
*******************************************************************************************************************************
APPLICANT’S STATEMENT
I certify that all statements on this form are true and accurate, and that funds will be provided as specified above. I will notify the
University of Wisconsin-Stevens Point of any changes in my financial circumstances or those of my sponsor. I understand that
failure on my part or that of my sponsor to provide the needed funds regardless of prior admission and registration will result in
the cancellation of my registration and my termination from the undergraduate program at the University of Wisconsin-Stevens
Point.
Student’s Printed Name
__________________________
Date
__________________________
April 2016
Student’s Signature
__________________________
Financial Support Statement for International UWSP Undergraduate Program Applicants
Estimated expenses for nine (9) months of study during the 2016-2017 academic year at the University of Wisconsin-Stevens
Point are as follows (in USD):
Tuition and fees (approximate)
Campus Housing
Campus Meal Service
Health & Accident Insurance
Total
16,120.00
4260.00
3252.00
1430.00
$25,062.00
PLEASE NOTE: This is a relatively conservative budget for a student
who spends wisely and is willing to share on campus living quarters
with another student. While some students may need less money,
many students find that they spend more than this amount. This
estimate does not include the cost of international travel or keeping
an automobile.
*Insurance premium for one calendar year: August 5, 2016 – August 4, 2017
Expenses may vary from estimates.
Official tuition rates are set in August.
Name of Applicant:
Semester you plan to enter
Family Name
Given Name
Middle Name (if applicable)
_____ Fall (September)
_____ Spring (January)
Year _____
Choose ONE:
_____ I will be self-supporting. (Please
submit original bank statement* showing
available funds of at least $25,062)
_____ I will be sponsored by one or
more individuals. (Please have sponsor(s)
_____ I will be government-sponsored.
(Please submit official documentation verifying
government support)
complete form(s) and submit bank statements*
totaling at least $25,062)
*An original bank statement is one on bank letterhead, with an official seal. We will accept faxed documents only if faxed directly from your bank or the
sponsor’s bank. Your application for admission will not be considered unless both statements below are completed and supported by the requested official
documentation.
*******************************************************************************************************************************
SPONSOR’S STATEMENT
I, __________________________________, certify that I have read and understand the above financial support statement. I
further certify that I have the financial resources to cover the expenses of the student, __________________________________,
in the amount of $ __________ per year in addition for travel expenses for a round trip from the student’s home to the
University of Wisconsin-Stevens Point for each calendar year while this individual is in the United States. An original bank
statement on bank letterhead reflecting a balance of at least this amount in U.S. currency is attached. I understand that the
inclusion of any false information concerning financial support will be considered grounds for the student’s dismissal from the
University of Wisconsin-Stevens Point.
Sponsor’s Printed Name
__________________________
Sponsor’s Signature
__________________________
Date
__________________________
Relationship to Student
__________________________
*******************************************************************************************************************************
APPLICANT’S STATEMENT
I certify that all statements on this form are true and accurate, and that funds will be provided as specified above. I will notify the
University of Wisconsin-Stevens Point of any changes in my financial circumstances or those of my sponsor. I understand that
failure on my part or that of my sponsor to provide the needed funds regardless of prior admission and registration will result in
the cancellation of my registration and my termination from the undergraduate program at the University of Wisconsin-Stevens
Point.
Student’s Printed Name
__________________________
Date
__________________________
April 2016
Student’s Signature
__________________________
UWSP Housing Policies & Room Assignment Questionnaire
University regulations require all ESL Program and undergraduate students to stay in the residence halls (dormitories) unless they are over 21
years old, married, or third year undergraduate students. Room assignments for new students are in “double” (shared) rooms. Single rooms
may be available after one semester of study. Single room assignments are based upon availability and resident seniority (length of time in the
residence halls). There is an additional charge for a single room.
Kindly answer the following questions. Your responses will assist the UWSP Office of Residential Living as they make your housing assignment:
1.
Do you smoke?
YES
NO
2.
Would you prefer to live on an alcohol-free floor?
YES
NO
I understand that I must arrive at the University of Wisconsin – Stevens Point prior to the start of the New Student Orientation Program and
that I will be charged for housing during orientation week. I may check-in a few days before the start of orientation week and understand that
such pre-orientation housing is also charged on a weekly basis. Campus food service will not be available until school begins. I will complete a
regular UWSP Office of Residential Living housing contract during orientation.
Your signature
Date
Month and Year of High School Graduation
Please send application form, academic credentials, financial documentation, and application fees to:
UW-Stevens Point International Admissions
c/o Brad Van Den Elzen
1801 Fourth Avenue, CCC 108
Stevens Point, WI 54481-1907
USA
Telephone: +1 (715) 346-3849
April 2016
Credit Card Payment Form
I,
, hereby authorize UWSP to charge my credit card
account in the amount of:
 $100 University Application Fee
 $150 English as a Second Language Program and University Application Fee
 $100 English as a Second Language Program only Application Fee
 $110 University Graduate Application Fee
Type of Credit/Debit Card (circle one):
VISA
Master Card
Discover
Expiration Date: __ __ / __ __
Month Year
Please print this form and fax it to
1-715-346-3591
Print Credit Card Holder’s Full Name
Student Name
Credit Card Holder’s Street Address
Phone
City
Country
Country Code or Zip Code
/
Card Number
Signature
April 2016
CV Code
Month / Year of Card Expiration Date
Today’s Date