UIC Undergraduate International Applicant
Payment page

Applicant Name:     _______________________________________________________________

Address:                  _______________________________________________________________

City, State:   ____________________________________   Nation:   ________________________

Zip:  _______________________

Application Term:                _____Fall _____Spring _____ Summer 20_____

Date of Birth:    _________________     Social Security Number (optional):   _________________________

Thank you for applying for admission to the University of Illinois at Chicago. To complete your application, please follow the instructions below.
- Complete the Secondary School Form, making sure to include all courses that you will complete before entering college.
- Sign and send this document to the Office of Admissions and Records along with your Declaration & Certification of Finances Form.
- Have your secondary school counselor or principal send us your official academic record showing all courses taken and grades earned.
- You may give this form and your Declaration of Finances Form to your school to be sent in with your academic record.
- If you did not pay your $50.00 application fee by credit card, please include the check or money order with this form. Send, or have this information sent to:
University of Illinois at Chicago
Office of Admissions and Records
BOX 5220
CHICAGO, IL 60680-5220

SECONDARY SCHOOL COURSE FORM: In the space below, please list the names of courses in which you are currently enrolled in your final year of school and any summer courses you are planning to take before your intended term of entry. See the example below.

I understand that withholding pertinent information requested on this application, including attendance at any other institution, or giving false information may make me ineligible for admission to the University or subject to dismissal, if enrolled. I have read this application and certify that the statements I have made on this application are correct and complete, including a report of any and 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.

Please submit these two pages to your school principal or counselor. Your application cannot be considered complete without this information.

TO THE SECONDARY SCHOOL PRINCIPAL OR COUNSELOR:

We appreciate you taking the time to certify the applicant's rank in class/Grade Point Average (GPA) and number of years upon which it is based. Please mail the student's official academic record, fee (if no credit card payment) and this document to the following address as soon as possible.

University of Illinois at Chicago
Office of Admissions and Records
Box 5220
Chicago, Il 60680-5220

Rank:_______Class Size:_________Based on __________year's 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