2014 Summer Session Supplemental Application for International Students
Express delivery address: UCSD Extension Bldg. E, 9600 N. Torrey Pines Road, La Jolla, CA 92037, U.S.A, Tel: +1(858) 534-6784 Fax: +1(858) 534-5703
1. Personal Information
Family Name_______________________________________ First Name _____________________________________
Birthdate (mm/dd/yr)_____/_____/______ E-mail Address ___________________________________________________
2. The following documents must be included with this application:
□ UC San Diego Extension International Program application pages A3-A4
(http://extension.ucsd.edu/department/elp/howtoenroll/documents/2014_IPApplication.pdf?25-Feb-14)
□ Medical Insurance:
□ Enclosed is the Medical Insurance Verification Form (page A5 of the Extension International Programs application), OR
□ Student will purchase UC San Diego medical insurance for $225 USD per session
□ Proof of English proficiency: TOEFL (iBT) 90, IELTS 7.5, Advanced Cambridge: PASS, CEFR level C1
□ Copy of transcripts in English for the two most recent years of academic studies
□ Payment in full
□ Proof of available funds (showing a minimum of $8,415 USD for each full-time session) if I-20 is required
□ Tuberculosis (TB) Questionnaire/Assessment (page A6 of the Extension International Programs application)
3. Courses Selection:
•
Go to tritonlink.ucsd.edu to see which classes are offered for SSI and SSII.
•
You must have completed all course prerequisites for each class you select.
•
Check that each class you select does not have a time conflict with other classes you select.
•
Select alternate classes in the event that your first choice classes are unavailable.
•
Check each section I.D. number carefully to make sure it correlates with the course you want to enroll into.
•
Full-time students: select 2 classes and 2 alternate classes.
•
Part-time students: select 1 class and 1 alternate class.
SUMMER SESSION 1
Department
Course Number
Section I.D. Number
Example Class 1
BILD 3
3
4
8
1
8
4
6
Class 1
Alternate Class
Class 2
Alternate Class
SUMMER SESSION 1
Class 1
Alternate Class
Class 2
Alternate Class
4. Fee Calculation: Some classes require additional fees. If you need to pay extra fees, we will inform you after class enrollment.
ENROLLMENT FOR VISITING AND INTERNATIONAL STUDENTS BEGINS: APRIL 21, 2014.
NOTE: To ensure you obtain your choice in courses, please apply early to solidify your schedule on April 21, 2014, at the start of open-enrollment
for visiting and international students. While international students may begin reviewing courses beginning April 14, 2014 (the date that UC San
Diego students begin enrolling into Summer Session), international students may not enroll into courses until April 21, 2014.
Check the appropriate boxes:
Session I
June 30 – Aug. 2
 FT: $5,575 USD
 PT: $4,575 USD
Session II
Aug. 4 – Sept. 6
 FT: $5,575 USD
 PT: $4,575 USD
FT = Full-time, 8 units
PT = Part-time, 4 units
Required Application Fee:
Optional 3-day express mail (delivery of acceptance materials)
UC San Diego Medical Insurance ($225 USD per 5-week session)
Total Fees Due With This Application
Amount to be paid by credit card:
Payment Method:
Check or money order enclosed payable to UC Regents
Credit Card ____ Visa ____ Mastercard ____JCB ____AMEX
$ 200 USD
$ 50 USD
IF PAYING BY CREDIT CARD, SEND THIS FORM BY FAX TO:
$______USD
+1-858-534-5703.
$______USD
DO NOT SEND YOUR CREDIT CARD INFORMATION BY EMAIL.
$______USD
Credit Card Number ____________________________________________
Cardholder’s Name_____________________________________________
Expiration Date (mo/yr) _________________________________
Cardholder’s Signature__________________________________