Siena College



Siena College Application for Siena International ExchangeStudentPrint name exactly as it appears on passport MaleFirst Name _________________Last Name(s) ____________________ Middle Initial_____ Female(Given Name) (Family Name)Permanent AddressStreet Address_________________________________________________________________________________City____________________________ Province/State__________________________________________________ Postal Code_____________________ Country________________________________________________________ Home Phone (___) _________________ Cell Phone (___) __________________ Date of Birth ________________E-mail Address______________________________________ month/day/yearCountry of Birth______________________ Country of Citizenship________________________________________ Current Address (If different from the Permanent Address)Street Address_________________________________________________________________________________City____________________________ Province/State__________________________________________________ Postal Code_____________________ Country________________________________________________________Passport InformationPassport Number_____________________ Issuing Country_________________ Expiration Date_______________ month/day/yearAre you a U.S. Citizen? Yes or No Do you currently hold a visa to study in the US? Yes or NoIf yes, what is your visa status? ____________________Optional: How would you describe yourself? American Indian or Alaskan Native Hispanic/Latino Asian or Pacific Islander (including the India Subcontinent)White or Caucasian Black, African American/Non-Hispanic Other, please specify_________Please indicate briefly why you are interested in Siena College:____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ApplicationTerm you wish to enter: September 20 ____ January 20 ____ Partner University AffiliationSan Buenaventura, ColombiaCEFAM, FranceCaliRadboud, NetherlandsBogotáUniv. Franciscana, MexicoCartagenaFAE, BrazilMedellínEnglish Language ProficiencyIs English the primary language spoken at home? Yes NoHave you taken the TOEFL exam? Yes NoIf yes, what was the score? ______________(over)Major/Academic StudiesWhat is your major/field of study at your home institution? _________________________________________ Indicate the departments in which you intend to take classes at Siena (Check all that apply):SCHOOL OF BUSINESS Accounting Actuarial Science Economics/BS Finance Marketing Management Undecided BusinessSCHOOL OF LIBERAL ARTSAmerican StudiesClassicsCreative ArtsEconomics/BAEnglishFrenchHistoryPhilosophyPolitical ScienceReligious StudiesPsychologySocial WorkSociologySpanishSCHOOL OF SCIENCE BiologyBiochemistryComputer ScienceEnvironmental StudiesMathematics/BAMathematics/BSPhysics Certificate or Special ProgramsEducationPre-LawRevolutionary Era StudiesAcademicList all colleges/universities you have attended, with current or most recent first. College/University Location Dates of attendance Graduation date____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________List all courses in which you are currently enrolled:______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________PARENT/GUARDIANFather’s Full Name: _______________________________________ _____________________________________ Address if different from student: _________________________________________________________________Occupation: ____________________________________________Employer: ______________________________ Mother's Full Name: _______________________________________ ____________________________________Address if different from student: _________________________________________________________________Occupation: ____________________________________________Employer: ______________________________ Is there any other information that you want us to consider in interpreting your academic record? If so, please attach an additional statement with your application. ALL APPLICANTSI certify that the information I have submitted in this application is complete and true to the best of my knowledge. I agree that if I am accepted for admission, I will comply with all the rules and regulations of the College that may be in effect or that will be put into effect while I am a student.Student signature__________________________________________________ Date ________________ ................
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