University of Michigan-Dearborn
Graduate Studies Office
4901 Evergreen Road
1055 AB
Dearborn, Michigan 48128-2406
APPLICATION FOR ADMISSION
AS A RACKHAM GRADUATE GUEST IN DEARBORN
This form will serve as your application for admission as a Rackham graduate guest student at the University of MichiganDearborn.
All guest students are:
•
Subject to all UM-Dearborn admission and registration regulations.
•
Not in a degree-seeking program at UM-Dearborn.
•
Responsible for determining if their home institution will accept credit earned as a guest student. The departmental
signature (from your home institution) at the end of this application acknowledges acceptance.
•
Responsible for arranging to have a transcript of any guest credit earned as a guest student sent from UM-Dearborn to their
home institution.
•
Admitted for one term only.
•
Responsible for understanding and adhering to the residency regulations as printed in the UM-Dearborn Graduate
Announcement.
•
Assessed regular UM-Dearborn graduate tuition and related fees for all courses elected.
PERSONAL INFORMATION
Social Security
Number_____________________________
Admission Requested for: Year___________
Fall
Winter
Summer
Name:____________________________________________________________________________________________
Last
First
Middle
Maiden
Address:______________________________________
______________________________________
Gender: Male_____ Female_____
Date of Birth: _________________________
Phone Number: ________________________________
Home
________________________________
Office
________________________________
Mobile
Email: ________________________________________
Race/Ethnicity (Optional)
The information requested below is optional and will not be used for admissions purposes. It will be used to satisfy federal
reporting requirements and may be used for other purposes allowed by law.
Please indicate whether you consider yourself to be Hispanic or Latino.
Yes, Hispanic or Latino: a person of Cuban, Mexican, Chicano, Puerto Rican, South or Central American, or other Spanish
culture or origin, regardless of race.
No, not Hispanic or Latino.
In addition, select one or more of the following racial categories to describe yourself:
American Indian or Alaska Native: a person having origins in any of the original peoples of North and South America
(including Central America), and who maintains tribal affiliation or community attachment.
Asian: a person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent
including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and
Vietnam.
Black or African American: a person having origins in any black racial groups of Africa.
Native Hawaiian or Other Pacific Islander: a person having origins in any of the original peoples of Hawaii, Guam, Samoa, or
other Pacific Islands.
White: a person having origins in any of the original peoples of Europe, the Middle East, or North Africa.
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Are you a U.S. citizen?
Yes
No
If no, country of citizenship ______________________
Please indicate your current status in the U.S.A.:
U.S. Permanent Resident (green card holder)
Alien Registration # ____________________________
Temporary Visa Holder (F-1, J-1, etc.)
Type of Visa __________________________________
Read the University's Residency Guidelines at http://www.umich.edu/~regoff/resreg.html to determine if you are eligible for Michigan
Residency.
Are you a Michigan resident?
Yes, Since _________________
No
If you answered "yes" and any of the following circumstances apply, you must file an Application for Resident
Classification and be approved if you wish to be classified as a resident for tuition purposes:
* You are currently living outside the state of Michigan for purposes of education, employment, volunteer activities,
military service, travel, etc.
* You have attended or graduated from a non-Michigan college.
* You have had any type of employment or domicile outside the state of Michigan within the last three years.
* You are not a U.S. citizen or a Permanent Resident Alien (Permanent Resident Aliens must possess the 1551 card).
* Your spouse/partner/significant other/parent is in Michigan as a nonresident student, medical resident, fellow, or on
military assignment.
* You are 24 years of age or younger and either parent lives outside the state of Michigan.
* You are 24 years of age or younger and have attended or graduated from a high school outside the state of Michigan.
* You have attended or graduated from an out-of-state high school and have been involved in educational pursuits for
the majority of time since high school graduation.
* You previously attended any U-M campus (Ann Arbor, Dearborn, or Flint) as a nonresident.
Other circumstances may also require you to file a residency application.
Residency Applications can be obtained from the Residency Classification Office, 1210 LSA Building, 500 South State
Street, Ann Arbor, MI 48109-1382, phone (734) 764-1400. The deadline dates for submitting an Application for Resident
Classification apply to the term for which residency is sought and are as follows: September 30 for Fall Term, January 31
for Winter Term, July 31 for Spring, Spring/Summer, and Summer Terms. Applications must be received in the Residency
Classification Office by 5 p.m. EST on the deadline date. Applicants who do not file by the deadline will be responsible for
paying nonresident tuition. Exceptions will not be granted.
ACADEMIC INFORMATION
Last Degree Received: ______________________________________________________________________________
Received From What College/University: ________________________________________________________________
Most Recent/Current College Attended: ___________________________________
Ann Arbor
Flint
Department admitted to:_____________________________________________________
Have you previously applied to or attended UM-Dearborn?
Term(s) and year(s) applied:_____________________
Yes
No
Term(s) and year(s) attended: ______________________
Course Desired:____________________________________________________________
I certify that the answers I have given to all questions in this application are correct and complete to the best
of my knowledge. I agree to abide by the regulations of the University of Michigan-Dearborn while I am
enrolled.
_____________________________________________
Student’s Signature
________________________
Date
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HOME INSTITUTION APPROVAL
Department approval from the home institution is required for admission at UM-Dearborn under this status. The departmental
chairperson must sign below or attach written approval to this application.
List courses approved by home institution to be elected at
UM-Dearborn*
_______________________________________________
_______________________________________________
_______________________________________________
This student is currently an eligible student in the following
Rackham program:_______________________________
The following signature authorizes approval for Rackham guest
status at UM-Dearborn:
___________________________________
Signature
___________
Date
*Additional written approval may be required for some courses from UM-Dearborn departmental offices. Please contact department.
RACKHAM GRADUATE PROGRAMS AT THE UNIVERSITY OF MICHIGAN-DEARBORN
Please mail this application to the graduate program which offers the course.
Please contact the appropriate department for information regarding courses offered.
Graduate Studies Office (General Information) .....................................................................................(313)583-6321
Master of Arts
Education, 262A, 19000 Hubbard, Dearborn, MI 48126 ........................................................................(313)593-5091
Liberal Studies, 2200 SSB, 4901 Evergreen, Dearborn, MI 48128-2406 .............................................. (313)593-1183
Master of Science
Applied and Computational Mathematics, 2200 SSB, 4901 Evergreen, Dearborn, MI 48128-2406 ..... (313)593-1183
Computer and Information Science, 105 CIS, 4901 Evergreen, Dearborn, MI 48128-2406 .................(313)436-9145
Engineering Management, 2340 HPEC, 4901 Evergreen, Dearborn, MI 48128-2406 ..........................(313)593-5361
Environmental Science, 2200 SSB, 4901 Evergreen, Dearborn, MI 48128-2406 .................................(313)593-1183
Information Systems and Technology, 2340 HPEC, 4901 Evergreen, Dearborn, MI 48128-2406 ....... (313)593-5361
Software Engineering, 206 ELB, 4901 Evergreen, Dearborn, MI 48128-2406 ......................................(313)593-5420
Master of Public Administration, 2200 SSB, 4901 Evergreen, Dearborn, MI 48128-2406 ............... (313)593-1183
Master of Science in Engineering
Automotive Systems Engineering, 116 MSEL, 4901 Evergreen, Dearborn, MI 48128-2406 ................ (313)593-5582
Computer Engineering, 206 ELB, 4901 Evergreen, Dearborn, MI 48128-2406 .................................... (313)593-5420
Electrical Engineering, 206 ELB, 4901 Evergreen, Dearborn, MI 48128-2406 ..................................... (313)593-5420
Industrial and Systems Engineering, 2340 HPEC, 4901 Evergreen, Dearborn, MI 48128-2406 .......... (313)593-5361
Manufacturing Systems Engineering, 116 MSEL, 4901 Evergreen, Dearborn, MI 48128-2406 ........... (313)593-5582
Mechanical Engineering, 1340 HPEC, 4901 Evergreen, Dearborn, MI 48128-2406 ............................ (313)593-5241
Dual Degree
Master of Business Administration ........................................................................................................ (313)593-5460
and
Master of Science in Engineering, Industrial and Systems Engineering ............................................... (313)593-5361
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