UIC Graduate Certificate Applicant
Payment Page

__________________________________________________________________________________

Last / Family Name / Surname                               First / Given / Personal                            Middle

Address:                  _______________________________________________________________

City, State:   ____________________________________   Nation:   ________________________

Zip:  _______________________

Application Term:     _____Fall _____Spring _____ Summer              Year: 20_____

Intended Program _____________________________

Date of Birth:    _________________     Social Security Number:   _________________________

All Applicants:

Thank you for applying for admission to a certificate program at the University of Illinois at Chicago (UIC). To complete your file, please have your official transcripts, and test scores if required, sent to the Office of Admissions and Records. Please refer to the Graduate College Admissions website for further application requirements for your intended program.

If you are paying the $50.00 nonrefundable application fee by check or money order, please print and complete this document, include your check and send both to:
University of Illinois at Chicago
Office of Graduate Admissions (MC 018)
Box 7994
Chicago, Illinois 60680-7994
U.S.A

International Applicants:

Have your Test of English as a Foreign Language (TOEFL) scores sent to us if you do not qualify for a waiver of this requirement. Please see the International Graduate Application Instructions for further information about the English language waiver.

If you are applying to a certificate program where the instruction method is face to face or blended, complete the Declaration & Certification of Finances Form and send it to the Office of International Services. This form is not required if you are applying to an online certificate program.