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Student Identification Form This form is to be attached to any document you send in support of your application for admission.

Make as many copies as you need.

_______________________________________________________________________
Full name (family name, first name, middle name) as it appears on your application for admission. __________________________ Date of Birth (month, date, year) ____________________________ Electronic Application ID Number ____________________________ Student ID Number ( if known) or Social Security Number

Intended Major Level of Study ( Undergraduate / Graduate )

Return this form to the University of Houston Office of Admissions 4400 University Drive Houston, Texas 77204-2023 U.S.A.

NAME:
LAST FIRST MIDDLE

ID NUMBER:

SECTION E
STATEMENT OF UNDERSTANDING (Graduate)
Important: You must return this statement with your completed admission application. Instructions: Read the statements below carefully. You must agree to each of these statements before you will be considered for admission.

1. 2. 3. 4.

5. 6. 7. 8. 9. 10.

11. 12. 13. 14. 15. 16.

I understand that if English is not my native language,1 I must take the Test of English as a Foreign Language (TOEFL). I understand that if I am admitted to the university, I may be tested again for my English proficiency prior to registration at the university. On the basis of these scores, I understand I will be placed in the appropriate English courses for international students. I understand that I must make my own arrangements for housing. (To reserve a room in a University of Houston dormitory, I must apply to the director of housing several months before the semester begins.) I have read and understand all admission procedures. I understand that all documents and materials relating to my admission should be forwarded to the Office of Admissions. I also understand that the $75 U.S. application fee is not refundable and that my application will not be processed without the fee. I understand that I must give written permission to the University of Houston for anyone other than myself to request information about the status of my application and/or admission status. I understand that if I am unable to attend the University of Houston for the semester in which I am approved, a written request and an additional application fee may be required in order to update my file. I understand that I must submit an official, translated syllabus or course description of all course work taken at a foreign university or college by the application deadline in order to insure a transfer evaluation during my first enrolled semester. I understand that I must arrive in time to attend the one-week orientation for nonimmigrant international students; the cost of the orientation is $50 U.S. I understand that I must pay the international student insurance fee for medical/hospitalization coverage. Exemptions are made only for those with proof of a currently valid policy showing a minimum of $50,000 U.S. coverage, including insurance for repatriation and medical evacuation. I understand that I should have $19,350 U.S. available for my first year of study. This amount includes living expenses for 12 months. If attending summer school, add $4,000 for summer tuition. Of this amount, I must have a minimum of $6,000 U.S. in my possession to meet initial expenses when I arrive in Houston. I am advised to carry this in the form of travelers checks. These figures are subject to change with out notification. I understand that I must accept visa restrictions which prohibit off-campus employment. I understand that I should arrive in Houston on or before the date specified on the I-20 form or DS-2019. If I cannot arrive on time, I must request in writing that my application be considered for a subsequent semester and I may be requested to pay an additional fee. I understand that I must allow a minimum five weeks processing time. I understand that the University of Houston may release a portion or all of my record to any of the UH campuses. I understand if I do not attend, the University of Houston will maintain my documents for one academic year. I understand that all of my documents become the property of the University of Houston.

If you agree to fulfill all the requirements as stated above, please sign below.

Signature of Applicant

Date
1

Students from Australia, the Bahamas, Belize, the British Isles, English-speaking Canadian provinces, the Fiji Islands, Jamaica, Liberia, New Zealand, Sierra Leone, South Africa, Trinidad, the United States, the Virgin Islands, the West Indies and Zimbabwe are exempt from taking the TOEFL with exceptions as listed under the English Proficiency Requirements. U.S. high school graduates must take the SAT or ACT test. Undergraduate students who have successfully completed Level 6 of the University of Houston Language and Cultural Center are exempt from taking the TOEFL.

NAME:
LAST FIRST MIDDLE

ID NUMBER:

SECTION F
LETTER OF FINANCIAL BACKING
This form must be updated every six months. The Affidavit of Support form (I-134) is valid for one year from the signature date. The University of Houston requires confirmation of financial resources for applicants who hold an F or J visa. This statement must be completed and on file with the university prior to the release of immigration documents. Please print all information. The University of Houston reserves the right to request bank statements as supporting documentation. (NOTE: If self-sponsoring, you must include a recent bank statement showing assets of the $19,3501 amount times the number of years you will be attending.) This is to certify that I will assume full financial responsibility (a minimum of $19,3501 U.S. per year) for the support of

Name of Student attending the University of Houston

Social Security number or UH Identification Number

Country of Birth

Date of Birth

Country of Citizenship

Sponsors Signature 2

Date

Sponsors Full Name

Sponsors Relationship to Student

Sponsors Address

Telephone

These figures are subject to change without notification. This amount includes living expenses for 12 months. If attending summer school, add $4,000 for summer tuition.
1 2

To be signed by the student only when self-sponsoring. This information is necessary for the Certificate of Eligibility (I-20 form) or DS-2019.

DEPENDENT INFORMATION
If you are seeking entry for your dependent(s); i.e., spouse and children, you must provide us with the following information. Financial proof of $1,500 is required for each dependent. Family Name First Name Date of Birth Country of Birth Relationship to F-1 Student An overseas address is required for each dependent if different from the F-1 student. Street Street Street City/Province State ZIP Code Country

NAME:
LAST FIRST MIDDLE

ID NUMBER:

SECTION G
PERMISSION RELEASE

In order to protect your privacy rights, the Office of International Admissions requires that all students give written permission specifying the person who may have access to the information concerning the status of his or her application and/or admission to the University of Houston. If you wish to designate someone access to this information, please complete the information below: I,
(print your name)

, give
(print name of friend or relative)

permission to request information concerning the status of my application and/or admission status to the University of Houston. I further give permission to the University of Houston to release this information to this person upon request. I understand that the above named person(s) may be required to show proof of picture identification when requesting information in person. I also understand that if the information is requested by telephone by this person, complete information as to my 1) full name, 2) student number, 3) date of birth and 4) complete address must be stated in order for any information to be released from our office to the designated person.1 (your signature) (your student number) (date)
1

Confidentiality rights are not applicable to telephone inquiries.

ETHNIC BACKGROUND

Please indicate which of the following groups best describes your ethnic background. This information is voluntary and will be used in a nondiscriminatory manner, consistent with applicable civil rights laws. This information will be used for federal and/or state law reporting purposes only and will not be used in any admission or scholarship decisions. u u u u u American Indian/Alaskan Native African American/Black Asian/Pacific Islander Hispanic/Latino White/Non-Hispanic

ME:

LAST

FIRST

MIDDLE

ID NUMBER:

SECTION HDEGREE CLARIFICATION FORM, PART I


HIS PAGE MUST BE RETURNED WITH THE APPLICATION. Please mark any of the following that best describe degrees that you have or ill have completed prior to applying to the University of Houston. Please also indicate the country where degree(s) was(were) earned.
me of Degree xample: Length of Full-time Study (in years) Required for Degree Country Name
004 004 017 017 020 021

Name of Degree
Degree Objective Doctoral Degree Objective Master Degree Objective Undergraduate Diplom Diplom * Diplom ** Diplom *** Diplom **** Diplom-Ingenieur * Diplom-Ingenieur ** Diplom-Ingenieur *** Diplom-Ingenieur **** Diplom-Ingenieur Diploma Diploma * Diploma ** Diploma *** Diploma **** Doctor of Musical Arts Doctor Doctor of Education Foreign Certificate Doctor of Jurisprudence Kandidat Nauk * Kandidat Nauk ** Kandidat Nauk *** Kandidat Nauk **** Kandidat Nauk Licenciado Licenciado * Licenciado ** Licenciado *** Licenciado **** Bachelor of Laws

Length of Full-time Study (in years) Required for Degree


(DEG DR) (DEG MS) (DEG UN) (DIPLOM) (DIPLOMB) (DIPLOMQ) (DIPLOMM) (DIPLOMD) (DIP-INGB) (DIP-INGQ) (DIP-INGM) (DIP-INGD) (DIPIUG) (DIPLOMA) (DIPLOMAB) 601 501 001 126 162 762 562 662 161 761 561 661 125 132 163

Country Name

Bachelor of Arts
Bachelor of Arts Bachelor of Arts ++ Bachelor of Arts ++ Bachelor of Arts +++ Bachelor of Arts ++++ Bachelor Degree ** Bachelor Degree (Bachelor only) Bachelor of Accountancy Bachelor of Architecture Bachelor of Applied Science Bachelor of Business Admin. Bachelor of Behavioral Science Bachelor in Education Bachelor in Engineering Bachelor in Environ. Design Bachelor of Fine Arts Bachelor of General Studies Bachelor of Interdisciplinary Sci. Bachelor of Journalism Bachelor of Liberal Studies Bachelor of Music Bachelor of Music Education Bachelor of Science Bachelor of Science (second deg.) Bachelor of Science in Civil Eng. Bachelor of Science in Chem. Eng Bachelor of Science in Education Bachelor of Science in Elec. Eng. Bachelor of Science in Elec. Tech. Bachelor of Science in Geology Bachelor of Science in Indust. Eng Bachelor of Science in Mech. Eng. Bachelor of Social Work Bachelor of Science in Petrol. Eng. Bachelor of Science in Pharmacy Bachelor of Science in Pharmacy++ Bachelor of Science in Technology Bachelor of Science in Tech. ++ Candidatus * Candidatus ** Candidatus *** Candidatus **** Candidatus

(BA) (BA) (BA2) (BA2) (BA3) (BA4)

India

(BACHELOQ) 180 (BACHELOR) (BACY) (BARCH) (BAS) (BBA) (BBEHASCI) (BEDU) (BENGI) (BENVDESI) (BFA) 123 002 003 139 005 189 181 182 187 006

(DIPLOMAQ) 763 (DIPLOMAM) 563 (DIPLOMAD) 663 (DMA) (DOCTOR) (EDD) (FORCERT) (JD) 606 128 602 122 603

(BGENSTUD) 183 (BISCI) (BJOUR) (BLIBESTU) (BM) (BMED) (BS) (BS2) (BSCE) (BSCHE) (BSED) (BSEE) (BSELE) (BSGEO) (BSIE) (BSME) (BSOCWRK) (BSPETE) (BSPHR) (BSPHR 2) (BSTCH) (BSTECH2) 022 186 188 007 026 008 018 010 009 011 012 185 134 013 014 184 138 015 025 016 019

(KANDIDAB) 165 (KANDIDAQ) 765 KANDIDAM) 565 (KANDIDAD) 665 (KANDNAUK) 133 (LICENCI) (LICENCIB) (LICENCIQ) (LICENCIM) (LICENCID) (LLB)
FOR OFFICE USE ONLY

127 166 766 566 666 136

* First undergraduate degree ** First undergraduate degree plus 30 credit hours or one year of graduate studies *** First graduate degree **** Highest graduate degree + First degree ++ Second degree

(CANDIDAB) 160 (CANDIDAQ) 760 (CANDIDAM) 560 (CANDIDAD) 660 (CANDIDAT)


FOR OFFICE USE ONLY

+++ Third degree ++++ Fourth degree 1213 years of primary and secondary are required prior to the figure listed on all of the above. (E.g. Students from Philippines who only completed 10 years of primary and secondary prior to university studies, and whose bachelor degree required 4 years to total 14 years of formal education should indicate 2 as number of years required fordegree.)

129

ME:

LAST

FIRST

MIDDLE

ID NUMBER:

SECTION HDEGREE CLARIFICATION FORM, PART II


HIS PAGE MUST BE RETURNED WITH THE APPLICATION. Please mark any of the following that best describe degrees that you have or ill have completed prior to applying to the University of Houston. Please also indicate the country where degree(s) was(were) earned.
me of Degree
Master of Laws Master of Arts Magister Artium Magister Artium * Magister Artium ** Magister Artium *** Magister Artium **** Maitrise Maitrise * Maitrise ** Maitrise *** Maitrise **** Master of Architecture Master Degree Master of Arts in Teaching Master of Business Admin. Master of Civil Engineering Master of Chemical Engineering Master of Education Master of Education Master of Electrical Engineering Master of Engineering Master of Fine Arts Master of Hospitality Management Master of Industrial Engineering Master of Letters Master of Music Master of Mechanical Engineering Master of Public and Intl. Affairs Master of Science Master of Science in Acoustics Master of Science in Accountancy Master of Science in Admin. Master of Science in Biomed. Eng. Master of Science in Civil Eng. Master of Science in Chemical Eng Master of Science in Electrical Eng Master of Science in Environ. Eng. Master of Science in Industrial Eng Master of Science in Materials Eng Master of Science in Mech. Eng. Master of Science in Occup. Ed. Master of Science in Oper. Resrch. Master of Science in Occup. Tech.

Length of Full-time Study (in years) Required for Degree


(LLM) (MA) (MAGART) (MAGARTB) (MAGARTQ) (MAGARTM) (MAGARTD) (MAITRISE) (MAITRISB) (MAITRISQ) (MAITRISM) (MAITRISD) (MARCH) (MASTER) (MAT) MBA) (MCE) (MCHE) (MED) (MEDUC) (MEE) (MENGI) (MFA) (MHM) (MIE) (ML) (MM) (MME) (MPIA) (MS) (MSAC) (MSACY) (MSADMN) (MSBE) (MSCE) (MSCHE) (MSEE) (MSENVE) (MSIE) (MSMATE) (MSME) (MSOED) (MSOPR) (MSOT)
FOR OFFICE USE ONLY

Country Name
525 502 135 167 767 567 667 130 168 768 568 668 523 124 582 504 512 510 505 581 514 580 506 533 516 537 507 518 540 503 526 508 509 527 513 511 515 528 517 530 519 524 529 536

Name of Degree
Master of Science in Petro. Eng. Master of Science in Pharmacy Master of Science in Physio. Optics Master of Science in Physio. Optics Master of Science in Systems Eng. Master of Social Work Master of Technology Non-Degree Objective Doctoral Non-Degree Objective Law Non-Degree Objective Master Non-Degree Objective Undergrad. Doctor of Optometry Post-Bac Grad. Study Prerequisite Post-Bac Personal Enrichment Post-Bac Second Baccalaureate Deg Post-Bac Teacher Certification Doctor of Pharmacy + Doctor of Pharmacy ++ Doctor of Pharmacy +++ Doctor of Philosophy Professional Certification Professional Certification * Professional Certification ** Professional Certification *** Professional Certification **** Professional Development Sarjana Sarjana * Sarjana ** Sarjana *** Sarjana **** Second Degree Will transfer to other school pp to complete degree Visiting student for semester pp (include summ trans)

Length of Full-time Study (in years) Required for Degree


(MSPETE) (MSPHR) 531 520

Country Name

(MSPHYSOP) 521 (MSPO) (MSSYSE) (MSW) (MTCH) (NDO DR) (NDO LA) (NDO MS) (NDO UN) (OD) (PBGSP) (PBPE) (PBSBD) (PBTC) (PHARM D1) (PHARM D2) (PHARM D3) (PHD) (PRO CER) (PRO CERB) (PRO CERQ) (PRO CERM) (PRO CERQ) (PRO DEV) (SARJANA) (SARJANAB) (SARJANAQ) (SARJANAM) (SARJANAD) (SECDEG) 534 532 522 535 600 400 500 000 604 102 103 100 101 610 611 612 605 104 164 764 564 664 105 131 169 769 569 669 134

(TRAN DEG)

106

(VIS STU)
FOR OFFICE USE ONLY

107

* First undergraduate degree ** First undergraduate degree plus 30 credit hours or one year of graduate studies *** First graduate degree **** Highest graduate degree + First degree ++ Second degree +++ Third degree ++++ Fourth degree 1213 years of primary and secondary are required prior to the figure listed on all of the above. (E.g. Students from Philippines who only completed 10 years of primary and secondary prior to university studies, and whose bachelor degree required 4 years to total 14 years of formal education should indicate 2 as number of years required fordegree.)