Application for
International
Undergraduate Admission
For information on graduate, credential or colloquy,
please contact the Admission Office for appropriate application.
UNIVERSITY MISSION STATEMENT
Concordia University Irvine, guided by the Great Commission
of Christ Jesus and the Lutheran Confessions, empowers
students through the liberal arts and professional studies
for lives of learning, service and leadership
1530 Concordia West • Irvine, CA 92612-3203
Phone: (949) 214-3062
(800) 229-1200, ext. 3062
Fax: (949) 214-3062
E-mail: InternationalAdmissions@cui.edu
www.cui.edu
Please send application form and requested items to:
International Undergraduate Admission Office
Concordia University
1530 Concordia West
Irvine, CA 92612-3203
(949) 214-3062
InternationalAdmissions@cui.edu
Items required by International Enrollment Services:
1. Completed international Undergraduate Application Form with signature
2. $50 non-refundable application fee
3. Copy of passport
4.Essay
5. International Reference Form
6. Official Transcripts: High School GPA of 2.8 and above
(International Transcrpts may be evaluated through www.IERF.org or www.WES.org)
7. Proof of English Proficiency
• TOEFL(PBT 550/IBT 79-80)/IELTS (6.5) Score from within the past two years
• U.S. High School GPA of 2.8 and above
8. SAT or ACT scores (recommended)
9. Affidavit of Financial Support
10.Current Official Bank Statement
Please PRINT or type
Applicant’s name________________________________________________________________________________________________
Family Name (Sur Name)
Given Name
Applicant’s name________________________________________________________________________________________________
MiddleMaiden
Semester you plan to enroll at Concordia Fall________ Spring__________
Social Security No.____________ –________ – ___________ US ADDRESS (if available)
Street __________________________________________City ____________________________State __________ Zip_____________
NATIVE COUNTRY ADDRESS (I-20 will be mailed to this address)
Street _______________________________________________________________________________________________________
City ____________________________________________ Permant/Province ________________________ Postal Code______________
Country Home Phone: Country Code (_______ )_________ -________ Facebook Email:___________________________________________
Cell phone: (________ )_________ -__________ Twitter Username: _______________________________________________________
E-mail address:__________________________________________________________________________________________________
List only active address that you check frequently. This e-mail address will be used for electronic communication between the university and you.
PERSONAL BACKGROUND
Date of birth__________/________/__________ Place of Birth___________________________________________________________
MonthDay Year
Gender: q Male q Female
City
State
Country
Country of Citizenship:______________________________________________________________
Native Language_________________ Visa q F1 q H1 q L1 q Other_______ Visa IssueDate__________ VisaExpiration Date_________
(mm/dd/yyyy)(mm/dd/yyyy)
Passport Expiration Date ____________________ SEVIS Tracking Number N____________________
(mm/dd/yyyy)
Have you been convicted of a felony within the last seven years?
q Yes q No
FAMILY INFORMATION
Please complete your household information if you are single and under 25 years old:
q Father
q Stepfather q Legal Guardian
q Grad of CUI
q Mother q Stepmother
q Legal Guardian
q Grad of CUI
Name_______________________________________________ Name___________________________________________________
Home Phone (________) (________) _______________________
Home Phone (________) (________) ___________________________
Work/Cell Phone (________) (________) _____________________
Work/Cell Phone (________) (________) ________________________
E-mail________________________ Country ________________E-mail________________________ Country___________________
Address______________________________________________ Address_________________________________________________
City, State, Postal Code___________________________________ City, State, Postal Code______________________________________
Employer_____________________________________________ Employer________________________________________________
Title/position___________________________________________ Title/position______________________________________________
If you wish to identify an ethnic group, please indicate to which group
you belong:
q Native American
q Asian or Pacific Islander
q Latino/Chicano/Hispanic
q African American
q White (Caucasian)
q Other_____________
q Transfer (minimum of 24 semester units or 36
quarter units earned at the time of application)
Application Type (Freshmen only)
q Early Action (Dec. 1st)
2. Name___________________________________________________
City_____________________________________State___________
Country_________________________________________________
Dates attended____________________________________________
APPLYING TO CONCORDIA UNIVERSITY AS A:
q Freshman
q Readmit
ADDITIONAL SCHOOLS PREVIOUSLY ATTENDED:
Units completed at time of application____________________________
3. Name___________________________________________________
City_____________________________________State___________
Country_________________________________________________
q Regular Decision
Dates attended____________________________________________
Have you previously applied for admission to Concordia University Irvine?
Units completed at time of application____________________________
q Yes
Have you previously attended Concordia University Irvine/Christ College Irvine?
4. Name___________________________________________________
City_____________________________________State___________
q Yes
Country_________________________________________________
q No If yes, when?_______________________________
q No If yes, when?_______________________________
Are you a recruited athlete? q If yes, which sport?_____________q No
Do you request on-campus housing?
q Yes q No
(On-campus housing is required for all freshmen and transfer students unless
approved through a waiver process.)
RELIGIOUS AFFILIATION:
q Lutheran Church – Missouri Synod
q Evangelical Lutheran Church of America
q Non-Denominational Christian
q Presbyterian
q Other__________________________
q Baptist
q Catholic
q Methodist
q None
Congregation name____________________________________________
Pastor’s name_______________________________________________
Congregation address__________________________________________
City____________________________ State_______ Zip______________
Phone(______)_______________________________________________
ACADEMIC BACKGROUND:
Name of graduating high school___________________________________
High School Street ____________________________________________
_________________________________________________________
City_________________________________ State__________________
High School Country_____________________ High School GPA__________
Date of graduation_____________________________________________
If you are applying as a freshman, have you taken the SAT, ACT, TOEFL or IELTS?
q Yes
q No
If yes, which one? q SAT
q ACT
q TOEFL
q IELTS
Test Score__________________________________________________
If no, when did you plan to take it?________________________________
(Month/Year)
COLLEGE/UNIVERSITY CURRENTLY ATTENDING:
1. Name___________________________________________________
City_____________________________________State___________
Country_________________________________________________
Dates attended____________________________________________
Units completed at time of application____________________________
Dates attended____________________________________________
Units completed at time of application____________________________
(List additional schools attended on a separate sheet.)
PLEASE CHECK YOUR ACADEMIC INTEREST: Fields of Study
q Art
q Exercise and Sport Science
q Secondary Art Ed
q Coaching
q Studio Art
q Exercise Science
q Athletic Training
q Rehabilitation
q Behavioral Science
q Teacher Ed
q Anthropology
q Graphic Design
q General
q History
q Psychology
q Humanities
q Sociology
q Art
q Biblical Languages
q Communication
q Biology
q History
q Biological Research
q Literature
q Liberal Arts
q Music
q Medical Science
q Theatre
q Business Administration
q Writing
q Accounting
q Liberal Studies
q Finance
q Mathematics
q Management
q Music
q Marketing
q Church
q Sports Management
q Liberal Arts or Performance
q Chemistry
q Music Ed
q Chemical Research
q Political Science
q Pre-Med
q Psychology
q Secondary Teacher Ed
q Theatre
q Christian Education Leadership
q Theological Studies
q Communication
q Theology
q General
q Pre-Engineering
q Mass
q Pre-Law
q Speech
q Pre-Medicine
q Director of Christian Education
q Pre-Physical Therapy
q Director of Parish Music
q Pre-Social Work
q Education
q Pre-Psychology
q Economics
q Pre-Theatre
q Elementary Ed
q Pre-Theological Studies
q Secondary Ed
q Pre-Theology
q English
q Pre-Seminary
q Undecided
Are you planning to be a full-time Lutheran Church – Missouri Synod
q Yes q No q Undecided
church professional?
Please complete the following essay question as part of your application.
Creative people state that taking risks often promotes important discoveries in their lives or their work. Discuss a risk that has led to a
significant change (positive or negative) in your personal or academic life.
If you choose to complete your essay later, be sure to submit it to us at InternationalAdmissions@cui.edu. Be sure to include your Full Name (Sur Name
and First Name) at the top of the essay.
Concordia University seeks to develop wise, honorable and cultivated citizens. The university understands its mission to be guided by the Word of God,
particularly Christ’s Great Commission. Responsible behavior of all individuals, at all times, includes integrity, self-respect and willingness to support and
direct fellow students whose actions seem harmful to themselves or the university community. Concordia University students come from a wide variety of
backgrounds, including a variety of religious backgrounds, but all students are expected to be of high character, of good reputation and of earnest intent
to act in a manner consistent with the university’s principles and practices.
I hereby certify that the information set forth in this application is true to the best of my knowledge. All documents or other materials which relate to my
application for admission become the property of Concordia University. If admitted to CUI, I hereby agree to abide by all the rules and regulations set forth
by the University, particularly those articulated in the catalog and student handbook.
Applicant’s signature
Date
Parent’s (or guardian’s) signature If applicant is under 18
Date
08/12
0005