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Section 1 - STUDENT INFORMATION
Section 1 of 8
*
Name (as shown on passport)
Family Name
First Name
Middle Name
*
Date of Birth
(MM/DD/YYYY)
*
Gender:
Male
Female
--Select--
Afghanistan
Algeria
Argentina
Armenia
Australia
Austria
Azerbaijan
Bangladesh
Belarus
Belgium
Belize
Benin
Bolivia
Bosnia and Herzegovina
Brazil
British Virgin Islands*
Brunei
Bulgaria
Cambodia
Cameroon
Canada
Central African Republic
Chile
China
Colombia
Congo
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Czech Republic
Denmark
Dominica
Ecuador
Egypt
El Salvador
Estonia
Ethiopia
Finland
France
French Polynesia
Gabon
Georgia
Germany
Ghana
Greece
Guatemala
Haiti
Honduras
Hong Kong*
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Korea, South
Kuwait
Laos
Lebanon
Libya
Lithuania
Macedonia
Malaysia
Mexico
Moldova
Monaco
Mongolia
Morocco
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Norway
Oman
Pakistan
Panama
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico*
Qatar
Romania
Russia
Saudi Arabia
Senegal
Serbia
Singapore
Slovakia
Slovenia
South Africa
Spain
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Thailand
The Bahamas
Tonga
Tunisia
Turkey
Turkmenistan
Uganda
Ukraine
United Arab Emirates
United Kingdom (Great Britain)
United States
Uruguay
Uzbekistan
Venezuela
Vietnam
Yemen
Yugoslavia
Zambia
*
Country of Birth
--Select--
Afghanistan
Algeria
Argentina
Armenia
Australia
Austria
Azerbaijan
Bangladesh
Belarus
Belgium
Belize
Benin
Bolivia
Bosnia and Herzegovina
Brazil
British Virgin Islands*
Brunei
Bulgaria
Cambodia
Cameroon
Canada
Central African Republic
Chile
China
Colombia
Congo
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Czech Republic
Denmark
Dominica
Ecuador
Egypt
El Salvador
Estonia
Ethiopia
Finland
France
French Polynesia
Gabon
Georgia
Germany
Ghana
Greece
Guatemala
Haiti
Honduras
Hong Kong*
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Korea, South
Kuwait
Laos
Lebanon
Libya
Lithuania
Macedonia
Malaysia
Mexico
Moldova
Monaco
Mongolia
Morocco
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Norway
Oman
Pakistan
Panama
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico*
Qatar
Romania
Russia
Saudi Arabia
Senegal
Serbia
Singapore
Slovakia
Slovenia
South Africa
Spain
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Thailand
The Bahamas
Tonga
Tunisia
Turkey
Turkmenistan
Uganda
Ukraine
United Arab Emirates
United Kingdom (Great Britain)
United States
Uruguay
Uzbekistan
Venezuela
Vietnam
Yemen
Yugoslavia
Zambia
*
Country of Citizenship
Current Contact Information
*
E-mail Address(Required)
Telephone
Fax
U.S.Address (If you are already in the U.S.or already know where in the U.S.will reside)
Street Address
City
--Select--
AK
AL
AR
CA
CO
CT
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
State
Zip Code
Telephone