ADMISSIONS APPLICATION FORM

All fields followed by a * are optional

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Personal
Information

Mr. Ms.

First Name:

Middle:

Last Name:

If we will be receiving documents under any other name, please indicate name:

Social Security #*:	- -
*The social security number is required if the applicant intends to file a FAFSA Form for financial aid
Birthdate*:	19

Mailing Address

Street:		Apt:
City/Province:		State:
Zip/Postal:
Country

Work Address

Company:
Street*:
City/Province:		State*:
Zip/Postal*:
Country

Phone/Fax

HomePhone:
Work Phone:
Home Fax:
Work Fax:

E-mail

Please Enter your Email Address:
Enter your Email Address Again:
(Note: all email addresses must include the "@" symbol, for example: pclc@pace.edu)

Optional*

Ethnicity:

Other (please specify)
Gender:

Male

Female

Is English your native language? Yes No

Enrollment Date

Semester begins:	Fall
Please select year you wish to begin:
Have you previously applied to Pace University?	When?
Have you previously attended Pace University?	When? Which Campus:

Program
of Study

In submitting this application, you are applying to:

Pace School:	GCS	Pace Program:	Computing Studies
Pace Major Code:	DPS	Pace Degree:	DPS

Prior Colleges or Universities Attended

College or University name and Address	Date of Entrance	Date or Expected Date of Degree	Major	Degree Awarded

TOEFL

Have you taken or do you plan to take the TOEFL (Test of English as a Foreign Language) Exam? Yes No
If yes, When? (mm/dd/yyyy)

GRE

Have you taken or do you plan to take the GRE General Examination?
Yes No
If yes, When? (mm/dd/yyyy)

Citizenship

Are you a U.S. Citizen?

Yes No

Non-Citizen

If not a U.S. citizen, please indicate:

A. If accepted for admission to Pace University, Will you need a I-20
or IAP-66 for a student visa? Yes No

If no, please indicate visa status you will hold:

If yes, please provide the information below:

      Gender:                          Male Female
     Date of Birth:                    (mm/dd/yyyy)
     Occupation in Home Country:
     City of Birth:
     Country of Birth:
     Country of Citizenship:

B.Are you now in the USA? Yes No
     If yes, please indicate your present visa status below:

     Please indicate which college or organization issued your
     visa and the location:
     What is the expiration date of your visa?

Disciplinary Action

Were you ever the subject of disciplinary action
in secondary school or college?
Yes No
If yes, please explain below:

Survey*

Which of the following was the most significant factor
which prompted your application to Pace University?

Signature!
MANDATORY!

By Checking this Box I understand that in the course of my association with Pace University I will be given the privilege of taking part in many University activities, both on and off the University premises, including athletics, varsity and intramural, that are not a part of my course of study, and that I will also be afforded the opportunity of taking part in optional field trips under University auspices. In consideration of the foregoing privileges, I hereby agree to assume all risks of injury to person, or injury to or loss of property, and to hold Pace University harmless from any and all loss or damage that may be sustained any such activities or trips, or in going to or returning from such activities or trips, including athletics, varsity and intramural.
I DO NOT AGREE
I AGREE

By checking this Box, I understand that my admission to Pace University is a privilege and not a right, and I agree that my admission, if granted, my registration and continuance on the rolls and graduation are subject to all policies, rules, regulations and procedures set forth in the current bulletins, catalogs and other publications, and notices of Pace University and as they be amended, and further are subject to the right of the authorities of Pace University to require my withdrawal for scholastic, disciplinary or other reasons under circumstances deemed sufficient by them.
I DO NOT AGREE
I AGREE

By checking this box I guarantee that all the information answered above has been answered fully and correctly. Omission or falsification of information will constitute grounds for rescinding admission offer, disciplinary action and/or dismissal.
I DO NOT AGREE
I AGREE

Please be sure all of the information requested above has been answered fully and correctly. Omission or falsification of information will constitute grounds for rescinding admission offer, disciplinary action and/or dismissal.

Pace University does not discriminate against any person for any reason, including race, color, national or ethnic origin, religion, age, sex, sexual orientation or handicap.

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