Application for Admission
English as a Second Language Program
University of Wisconsin – Stevens Point
Application for: Year 20____
 August  October  January  March  June
BIOGRAPHIC INFORMATION
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
High school name, city, and country:
Month and year of high school graduation:
What is your expected length of study?
 one 8-week session
 three 8-week sessions
 two 8-week sessions
 four 8-week sessions
Did an education agent help you complete this application? If so, please
list agency name & representative.
REQUIRED ACADEMIC CREDENTIALS

Original high school transcripts

Any college/university transcripts (if applicable)
REQUIRED FINANCIAL CERTIFICATIONS

Applicants must complete the Financial Support Statement (see page 2) for UWSP English as a Second Language Program Students and submit supporting
bank/sponsor documents.
ADDITIONAL REQUIRED DOCUMENTS

Complete UWSP Housing Policies & Room Assignment Questionnaire & UWSP ESL Program Expectations & Policies Agreement (see page 3)

Copy of passport photo page

Application fee (credit card authorization form or bank check/money order drawn on U.S. Dollars; see page 4)
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 fee is required and
non-refundable.
____________________________________________
_____________
_____________________________________________
_____________
Applicant Signature
Date
Signature of parent or sponsor if applicant is under 21 years of age
Date
Send:





This ESL Program Application for Admission (pages 1 – 4)
Original Financial Statement Form
Original transcripts
Copy of passport photo page (including dependents)
Application fee
To:
UW-Stevens Point International Admissions
c/o Brad Van Den Elzen
1801 Fourth Avenue, CCC Room 108
Stevens Point, WI 54481-1907
USA
+1 (715) 346-3849
Do you have questions about completing this application?
If so, please contact the UWSP International Students & Scholars Office: isso@uwsp.edu
September 2015
Financial Support Statement for UWSP English as a Second Language Program Applicants
Estimated expenses for two sessions (16 weeks) of study during the 2015-2016 academic year at the University of Wisconsin-Stevens
Point are as follows (in USD):
Tuition and Fees
Campus Housing
Campus Meal Service
Insurance & Textbooks
Total
5500.00
2049.00
1594.00
1115.00
$10,258.00
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 daily spending money, the cost of international travel, or
keeping an automobile. Expenses may vary from estimates.
Official tuition rates may change at any time.
Please note that personal expenses are not included in this estimate
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 during orientation.
Full payment for required medical insurance is due upon arrival. Non-UWSP insurance policies are not permitted.
Name of Applicant:
Session you plan to enter:
Family Name
Given Name
Middle Name (if applicable)
Year 20_____
_____ Spring I (January)
_____ Fall I (August)
_____ 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 $10,258)
_____ I will be sponsored by one or more
individuals. (Please have sponsor(s) complete
_____ I will be government-sponsored.
(Please submit official documentation verifying
government support)
form(s) and submit bank statements* totaling at
least $10,258)
*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 WisconsinStevens 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
__________________________
September 2015
Student’s Signature
__________________________
UWSP Housing Policies & Room Assignment Questionnaire
UWSP requires ESL Program students to stay in campus residence halls (dormitories) unless they are over 21 years old or married (with your spouse
traveling with you). 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.
What is your birthdate? (mm/dd/yyyy)
2.
What is your current age?
3.
Are you married?

If yes, will your spouse be traveling to UWSP with you?
YES
NO
YES
NO
4.
Do you smoke?
YES
NO
5.
Do 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 preorientation housing is also charged on a weekly basis. I will complete a regular UWSP Office of Residential Living housing contract during
orientation.
Your signature
Date
Month and Year of High School Graduation
UWSP ESL Program Expectations & Policies Agreement
ESL Program students are responsible for putting forth their best efforts.
Please read the following statements and signify your understanding of these expectations by ticking the response box and signing below.
Please “check” (√) to signify your understanding of these
statements
1.
I agree to attend all ESL Program classes. I understand that if my attendance
falls below 85% in any class I may be placed on probation.
2.
I must actively study and participate in my ESL classes and have a grade
point (GPA) of 2.0 or higher at all times. If not, I need to repeat a class more
than three times, I will be placed on probation
3.
I will make prompt payment for all UW-Stevens Point charges when billed. I
understand I cannot enroll in a new session without paying for the previous
session.
Name (print):
_________________________________________
Signature:
_________________________________________
Date (mm/dd/yyyy):
_________________________________________
September 2015
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
1-715-346-3819
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
September 2015
CV Code
Month / Year of Card Expiration Date
Today’s Date