UNG EducationUSA Academy Application

Please fill out all of the required information.

Contact Information
Family Name/Last Name

As it appears on your passport
First Name
Middle Name
Phone Number
Email
Mailing Address Mailing Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Is your permanent address different from your mailing address?

Is your permanent address different from your mailing address? Yes No
Foreign Non-U.S. Permanent Address Foreign Non-U.S. Permanent Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Personal Information
Date of Birth Date of Birth / MM / DD YYYY
Gender

Gender Male Female Other Other
City and Country of Birth
Country of Citizenship
Passport Number
Current Visa Status
Do you already reside in the United States?

Do you already reside in the United States? Yes No Other Other
What was your date of entry? What was your date of entry? / MM / DD YYYY
If you have a Visa, what is the expiration date? If you have a Visa, what is the expiration date? / MM / DD YYYY
Emergency Contact

Please fill out with your emergency contact's information.
Full Name
Relationship
Phone Number
Email
Education Background

List in chronological order all educational institutions you have attended, beginning with your last one. Please provide full name and address of each institution.
Name of School
School's Address School's Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Start Date Start Date / MM / DD YYYY
End Date End Date / MM / DD YYYY
Name of Degree or Certification
Do you need to add another school?

Do you need to add another school? Yes No
Name of School
School's Address School's Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Start Date Start Date / MM / DD YYYY
End Date End Date / MM / DD YYYY
Name of Degree or Certification
Do you need to add another school?

Do you need to add another school? Yes No
Name of School
School's Address School's Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Start Date Start Date / MM / DD YYYY
End Date End Date / MM / DD YYYY
Name of Degree or Certification
Additional Information

Please provide as much detail as possible for the following questions.
Meal Preferences

Please list any foods you will not eat.
Food Allergies

Please list any and all food allergies you have.
Health Issues

Please list any health issues (physical, mental, or emotional) you have.
What are your personal hobbies?

Please tell us about yourself.
How did you learn about us?
By checking this box, I confirm that all information is accurate and true. I understand that I must also show proof of permission to attend the EducationUSA Academy from a legal guardian or parent.

By checking this box, I confirm that all information is accurate and true. I understand that I must also show proof of permission to attend the EducationUSA Academy from a legal guardian or parent. I confirm.
Draw your signature into the box below.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Parent or Legal Guardian's Signature:

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Parent or Legal Guardian's Full Name
Date Date / MM / DD YYYY

UNG EducationUSA Academy Application

UNG EducationUSA Academy Application

Contact Information

Personal Information

Emergency Contact

Education Background

Additional Information