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:   _________________________

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 $50 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 Admissions (MC 018)
University of Illinois at Chicago
Box 7994
Chicago, Illinois 60680-7994