Student Data Form printable pdf download

University of Maine System International Student Data Form

Please print all information clearly. This form MUST accompany a U Maine System application form and application fee. Separate

copies of the application forms, test scores, academic records and financial documents must be sent individually with a separate

application fee to each of the University of Maine System campuses you wish to apply to. Canadian citizens should check with each

campus before completing this form, since it may not be required for Canadians at all campuses. U.S. Permanent Residents do not

need to complete this form.

Name: ___________________________________________________________________________________

Family/Last/Surname

Given/First name

Middle Name(s)

Name on previous records: _________________________________________________________________________

Family/Last/Surname

Given/First name

Middle Name(s)

Permanent home address: __________________________________________________________________________

Mailing address/Street/PO box

__________________________________________________________________________

City

State/Province

Postal Code

Country

E-mail address: ____________________________________

Fax number: ________________________________

Country code Area/City Code/ local number

Day-time telephone: _______________________________ Evening phone: ______________________________

Country code Area/City Code/ local number

Male: __ Female: __ Date of Birth: ____________________ Place of birth: _______________________________

Month – Day – Year

City

Country

Country of Citizenship: ________________________________ Native Language: __________________________

If you have a US Social Security Number, list the number: ______________________________________________

Do you hold a valid US Visa? Yes: __ No: __ If Yes, what type: F-1: __ B-1: __ Other (please specify); ______

If yes, please enclose a copy of your current visa and I-20 or I-94

Have you ever been or are you now in the U.S.? Yes __ No __ If yes, please explain: ______________________

__________________________________________________________________________________________________

List campus to which you are applying: _____________________________________________________________

List first choice program of study to which you are applying: ___________________________________________

List second choice program of study to which you are applying: _________________________________________

If English is not your native language, you must submit your results on the Test of English as a Foreign

Language (TOEFL). Indicate the date you have taken or will take the TOEFL: ____________________________

Month – Day – Year

Academic information: List, in the order that you attended, all secondary and post secondary educational

institutions you have attended. You must provide official copies of all academic transcripts, certificates,

diplomas or degrees earned, along with certified translations in English for each of the institutions listed.

Full disclosure of all schools, colleges and universities attended is required, even if you didn’t earn a degree.

Name of School

Address/City/ Country

Dates attended

Level/Certificate/Diploma/Degree

________________________ ___________________________ _____________ ____________________________

Please use another sheet of paper if you need more space to list academic information

This form MUST accompany a University of Maine System application form. Canadian citizens should check with each campus before completing this

form. U. S. Permanent residents do not need to complete this form. Questions should be addressed to the campus to which you are applying.

Student Data Form

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