UIC Undergraduate Domestic Applicant
Payment page
Applicant Name: _______________________________________________________________
Address:
_______________________________________________________________
City, State: ____________________________________ Nation:
________________________
Zip: _______________________
Application Term:
_____Fall _____Spring _____ Summer 20_____
Date of Birth: _________________ Social
Security Number: _________________________
Thank you for applying for admission to the University of Illinois at Chicago.
To complete your application, please follow the instructions below:
- Complete the High School Course Form making sure you include all courses that
you will complete before your term of entry.
- Read and sign the document and turn it into your high school counselor so
he/she can complete the Counselor section.
- If you are paying your $40.00 non-refundable application fee by check or money order, give
it to your counselor to mail in with this document and your official high school
transcript.
- If you are out of high school, just sign the document below; include your non-refundable
application fee if you are paying by check or money order, and request that
your high school send us your official high school transcript. You do not have
to have the Counselor form completed.
HIGH SCHOOL COURSE FORM: In the space below, please list the names and number of semesters of your senior year courses and any summer courses you are planning to take before your intended term of entry. See the example below.
| Example: Senior Year course - French IV, Fall (first semester) | |
I understand that withholding pertinent information requested on this application or giving false information will make me ineligible for admission to the University of Illinois at Chicago or subject to cancellation of registration if admission has occurred or dismissal if already enrolled. I certify that the statements on this application are correct and complete, including a report of all college courses attempted or completed.
Please submit this form to your high school counselor. These documents must be received by the Office of Admissions and Records before your application is considered complete.
TO THE HIGH SCHOOL COUNSELOR:
We appreciate you taking the time to certify the applicant’s rank in class/GPA and number of semesters upon which it is based. Please mail the student’s official transcript, fee (if student has not paid by credit card) and this document to the following address as soon as possible. In addition, if the student is requesting an application fee waiver due to extreme financial hardship, please provide the documentation below.
Rank:_______Class Size:_________Based on __________semesters” work
______We do not rank our students. Cumulative GPA (A=4.0)___________
___________________________________________________________
Name and title of certifying officer (please print or type)
___________________________________________________________
Phone number and extension/E-mail address
________________________________________ ________________
Signature
Date
I verify that ____________________________(student’s name) qualifies for an
application fee waiver for one or more of the following reasons.
______Family receives public assistance verified by a public aid or Medicaid
card that I have seen.
______Student qualifies for the free (not reduced) lunch program.
______The expected family contribution toward the student’s college education
is $0 verified by the Office of Financial Aid at UIC.
___________________________________________________________
Name and title of certifying officer (please print or type)
___________________________________________________________
Phone number and extension/E-mail address
________________________________________ ________________
Signature
Date