Personal Information First Name * Middle Name Last Name * Other Name(s) Other Last Name(s) or Surname(s), if any, that may appear on transcripts, documents, scores, etc. Gender * Gender * Male Female Date of Birth * Year Year195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021202220232024 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Country of Birth * City of Birth * Country of Citizenship * Email Address * Native Language * What will your immigration status be? * F-1 (Student) F-2 (Dependent of F-1) H (Temporary Worker/Trainee) U.S. Permanent Resident or Citizen Other, please specify: What will your immigration status be? Other, please specify: Study Plans Please check on option below you are applying for Undergraduate or Graduate Status or ESL * Undergraduate or Graduate Status or ESL * Conditional Undergraduate Admission Conditional Graduate Admission ESL Only Intended Major * Term * Term * Fall 2024 Spring 2025 Module * Module * Module 1 Module 2 Please Check http://www.ysu.edu/english-language-institute/program for term and module info. Please check one option below you are applying for * Please check one option below you are applying for * Full-time study Part-time study Where do you plan on living? Where do you plan on living? On-Campus housing Off-Campus housing Are you transferring to YSU ESL Program from another school in the US? Are you transferring to the ESL at Youngstown State University from another school in the US? Yes No Current Mailing Address Complete these lines as you would address an envelope to be mailed to yourself. If your address changes, please notify the Office of International Admissions at intadm@ysu.edu. If you are in the United States, you must list your U.S. address and number. Address Line 1: * Address Line 2: City * State/Province Postal (Zip) Code: Country: * Contact Phone Permanent Foreign Home Address Is your current mailing address the same as your address outside of the US? * Is your current mailing address the same as your address outside of the US? * Yes No Address Line 1: * Address Line 2: City * State/Province Postal (Zip) Code: Country: * Are you referred by an agent? Are you referred by an agent? Yes No Agent Name: Agent Email: Agent Address High School Information Your high school name and address * Please type the name and address of your high school. High school start date Year Year19701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010201120122013201420152016201720182019202020212022 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 High school graduation date * If you have not graduated yet, please select your anticipated graduation date. Year Year19701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010201120122013201420152016201720182019202020212022202320242025 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 College Information Have you attended other colleges/universities and earned credits before? * If you have attended a non-credit bearing ESL program in other colleges/universities, please select "No" Yes No College name and address Please type the name and address of the latest college you have attended. College start date Year Year20222023202420252026 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 College end date Year Year20222023202420252026 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Leave this field blank CAPTCHAThis question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
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