UIC Graduate Domestic 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 (optional):   _________________________


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

If you are paying your $60 nonrefundable application fee by check or money order, please print & complete this document, include your check and send both to:
University of Illinois at Chicago
Office of Graduate and Professional Admissions (MC 018)
University of Illinois at Chicago
Box 7994
Chicago, Illinois 60680-7994