LEAP Admission Application

Indicate the quarter and year you wish to enroll if admitted:

Indicate how long you wish to be in the LEAP program:

Personal Information

Last Name: 
First Name:
Middle:
Current Mailing Address:
Phone Number:
Email:
Birthdate:
Sex: 
 Male  Female
Married:
 Yes  No 
Country of citizenship:
City & Country of Birth:

Are you in the U.S.?

If yes, indicate what type of visa you have : 

Date of first entry to the U.S. (MM/DD/YYYY):

Are you outside the U.S.?

If yes, indicate the visa you intend to enter the country with: 

F-1  J-1  Other 

Nearest Relative: 
 Parent  Spouse
Enter full name: 
Relative's Address:
Relative's Phone Number: 

 

Academic Information
Have you previously applied for LEAP? 
 Yes  No 
Will you apply for campus housing? 
 Yes  No 
High School:
City:
Country:
Graduation date:

Please list all academic programs you have attended beyond high school: 

Programs or Schools Attended
City/State/Country
Attendance Dates
Hours in class per day

 

Educational Background

In the space below, please state briefly your personal background and educational objectives: 

If you have been out of school for more that one year, list and describe your occupation or work experience during that time beginning with the most recent experience: 

The information given above is complete and accurate to the best of my knowledge. I understand that misrepresentation of facts on this application will be cause for refusal of admission, cancellation or admission, or dismissal from the university. The university also reserves the right to revoke any degree or diploma that it may have awarded in reliance on information contained in the application for admission and it subsequently transpires that this information was a fraudulent misrepresentation of fact. By signing this application, I agree to abide by the policies and regulations of the university. 

Type your name here: 
Date: 

Return to LEAP Application Instructions