Personal Information

University ID Number (If known):

First (Given) Name:

Middle Name:

Last (Family/Surname) Name:

Date of Birth (mm/dd/yyyy):
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Gender:
Male   Female

Current Immigration Status:

Your E-mail Address:

Phone Number:

Street Address:

City:

State:

Postal Code:

Country:

Previous Application

Previous Term:
Select Fall Spring Summer
Year (YYYY):
Did you enroll for classes for the above term? Degree Earned?:
No
Yes

Indicate type of previous application:
(if you are changing your application type, you must submit a new application):
Select Undergraduate-Degree Seeking Graduate-Degree Seeking Undergraduate-Non Degree
Graduate-Non Degree

Desired Term and Major

Term
Select Fall Spring Summer
Year (YYYY):
Major:

Have you attended another educational institution since your last application?

Name of Institution:

Institution City, State and Country:

Dates Attended:

Degree Earned?:
No
Yes
Name of Degree:

Planned Courses

Comments

Confirmation Agreement

I understand that withholding pertinent information requested on this application or giving false information will make me ineligible for admission to IUPUI or subject to cancellation of admission if admission has already been granted or if dismissal if already enrolled. I certify that all statements on this application are correct and complete, including the list of all schools attended.

If necessary, I have enclosed a letter describing any criminal or disciplinary history as described in the application instructions. The letter and application will be sent by certified mail and I will keep the receipt certifying that it was received by IUPUI. The letter contains a statement granting my permission to officials at all institutions and agencies involved to release information needed by IUPUI to substantiate statements I have made in my application or my letter.

Do you certify that all statements on this application are correct and complete?

No
Yes